Analysis of Risk and Benefit of Open Lung Biopsy in Severe Immunocompromised Patients with Pulmonary Complications

I, Ho Seok; Lee, Sung Ho; Kim, Kwhan Mien; Shim, Young Mog; Han, Jung Ho; Lee, Kyung Soo; Kim, Jhin Gook

Abstract

BACKGROUND: Pulmonary complications in immunocompromised patients are often fatal. Empirical treatment is usually applied based on the clinical and radiological findings because of the risk of the aggressive diagnostic procedures such as open lung biopsy. However, recent advancements in operative procedures and perioperative management has decreased the procedure-related risks. We have prospectively analyzed the risks and benefits of the early application of open lung biopsy in such patients. MATERIAL AND METHOD: Forty-two consecutive immunocompromised patients with critical pulmonary complications were included from June, 1996 to December, 1999. The definition of the immunocompromised is as those with chemotherapy and/or other modality for hematologic disorders, with usage of immunosuppressive drug after transplantation, with usage of steroid for more than 1 month, and with primary immunodeficiency disorders. The indication of open lung biopsy was those with no significant improvement after a week of aggressive application of empirical treatment or with rapidly aggressive process. The underlying disease included hematologic disorder(31 patients), post-transplantation(3 patients), chemotherapy for solid tumor(2 patients), and others(6 patients). Operations were done through thoracotomy(conventional or mini-) or VATS. RESULT: One patient died on the first postoperative day and seven patients died in the hospital after the operation but none was related to the operation. Preoperative usage of steroid and preoperative mechanical ventilator-dependency was significantly related to the in-hospital mortality but the other factors such as thrombocytopenia and neutropenia had no relation to the in-hospital mortality. There was no major or minor surgical complication except for prolonged air leak(1 patient). Postoperative diagnosis included infectious diseases (26 diagnoses; fungal, 20; pyogenic bacteria, 3; mycobacteria, 2; viral, 1), inflammatory disorders(6 diagnoses), malignancy(2 diagnoses), and nonspecifically-defined disorders(13 diagnoses). In 35 patients(81.4%) treatment plans were changed after open lung biopsy and 30 patients(69.8%) improved after change of treatment.
CONCLUSION
Open lung biopsy in immunocompromised patients with pulmonary complications can be done with acceptable risk and significant benefit. For accurate diagnosis, adequate treatment, and better prognosis, the early application of open lung biopsy should be considered when the empirical treatment does not improve the patient's condition.