A Prospective Study of 273 BAL Procedures

Study objectives: To evaluate the frequency and diagnostic significance of alveolar hemorrhage (AH) in HIV-infected patients. Design: A 3-year prospective cohort study. Setting: A university hospital in Paris, France. Patients: Two hundred forty-three HIV-infected patients undergoing 273 BAL procedures during the study period. Methods: AH was assessed by using the Golde score. Data on the patients treated and observed in our institution were collected, as well as on their survival rate 12 months after undergoing BAL. Risk factors for AH were sought by comparing patients with AH (cases) and those without AH (control subjects). Results: AH frequently occurred but usually was subclinical and cytologically mild. AH did not alter the 12-month survival rate. AH always was associated with at least one specific AIDS-related pulmonary disorder, and the following four independent risk factors were identified in a stepwise forward logistic regression model: pulmonary Kaposi’s sarcoma (KS; odds ratio [OR], 5.3; 95% confidence interval [CI], 1.8 to 16.7; p 0.003), cytomegalovirus (CMV) pneumonia (OR, 9.8; 95% CI, 1 to 100; p 0.05), hydrostatic pulmonary edema (OR, 16.4; 95% CI, 1.8 to 142; p 0.01), and platelet count < 60,000 cells/L (OR, 5.6; 95% CI, 1.5 to 20; p 0.009). Conclusions: AH is frequently diagnosed during BAL in HIV-infected patients. Its presence may point to an underlying cause, such as pulmonary KS, CMV pneumonia, or hydrostatic pulmonary edema, or to triggering factors such as thrombocytopenia. (CHEST 2001; 120:1078 –1084)