{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T09:07:45Z","timestamp":1778058465877,"version":"3.51.4"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["j intensive care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cellular patterns in bronchoalveolar lavage fluid (BALF) are used to distinguish or rule out particular diseases in patients with acute respiratory failure (ARF). However, whether BALF cellular patterns can predict mortality or not is unknown. We test the hypothesis that BALF cellular patterns have predictive value for mortality in patients with ARF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective single-center observational study conducted in a Japanese University Hospital. Consecutive patients (<jats:italic>n<\/jats:italic>= 78) with both pulmonary infiltrates and ARF who were examined by bronchoalveolar lavage (BAL) between April 2015 and May 2018 with at least 1 year of follow-up were analyzed. Primary analysis was receiver operating characteristic curve\u2014area under the curve (ROC-AUC) analysis for 1-year mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the final sample size of 78 patients, survivors (<jats:italic>n<\/jats:italic>= 56) had significantly increased lymphocyte and eosinophil counts and decreased neutrophil counts in BALF compared with non-survivors (<jats:italic>n<\/jats:italic>= 22). Among the fractions, lymphocyte count was the most significantly different (30 [12-50] vs. 7.0 [2.9-13]%,<jats:italic>P<\/jats:italic>&lt;0.0001). In the ROC curve analysis of the association of BALF lymphocytes with 1-year mortality, the AUC was 0.787 (<jats:italic>P<\/jats:italic>&lt;0.0001, cut-off value [Youden index] 19.0%). Furthermore, \u226520% BALF lymphocytes were significantly associated with increased survival with adjustment for baseline imbalances (1-year adjusted hazard ratio, 0.0929; 95% confidence interval, 0.0147\u20130.323,<jats:italic>P<\/jats:italic>&lt;0.0001; 90-day<jats:italic>P<\/jats:italic>=0.0012). Increased survival was significantly associated with \u226520% BALF lymphocytes in both interstitial lung disease (ILD) and non-ILD subgroups (<jats:italic>P<\/jats:italic>=0.0052 and<jats:italic>P<\/jats:italic>=0.0033, respectively). In secondary outcome analysis, patients with \u226520% BALF lymphocytes had significantly increased ventilator-free days, which represents less respiratory dysfunction than those with &lt;20% BALF lymphocytes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the patients with ARF, \u226520% lymphocytes in BALF was associated with significantly less ventilatory support, lower mortality at both 90-day and 1-year follow-ups.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40560-021-00536-w","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T13:03:23Z","timestamp":1614085403000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prognostic value of lymphocyte counts in bronchoalveolar lavage fluid in patients with acute respiratory failure: a retrospective cohort study"],"prefix":"10.1186","volume":"9","author":[{"given":"Yasutaka","family":"Hirasawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4480-556X","authenticated-orcid":false,"given":"Taka-aki","family":"Nakada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Shimazui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuhiro","family":"Abe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuri","family":"Isaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Sakayori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichiro","family":"Yoshioka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Kawasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiro","family":"Terada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Tsushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichiro","family":"Tatsumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"536_CR1","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/S2213-2600(18)30345-X","volume":"7","author":"E Azoulay","year":"2019","unstructured":"Azoulay E, Mokart D, Kouatchet A, Demoule A, Lemiale V. Acute respiratory failure in immunocompromised adults. Lancet Respir Med. 2019;7:173\u201386.","journal-title":"Lancet Respir Med"},{"key":"536_CR2","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1002\/jhm.2004","volume":"8","author":"MS Stefan","year":"2013","unstructured":"Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Steingrub JS, Lagu T, et al. Epidemiology and outcomes of acute respiratory failure in the United States, 2001-2009: a national survey. J Hosp Med. 2013;8:76\u201382.","journal-title":"J Hosp Med"},{"issue":"Suppl 1","key":"536_CR3","doi-asserted-by":"publisher","first-page":"i1","DOI":"10.1136\/thoraxjnl-2013-203618","volume":"68","author":"IA Du Rand","year":"2013","unstructured":"Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013;68(Suppl 1):i1\u2013i44.","journal-title":"Thorax"},{"key":"536_CR4","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1164\/ajrccm\/142.2.481","volume":"142","author":"RA Goldstein","year":"1990","unstructured":"Goldstein RA, Rohatgi PK, Bergofsky EH, Block ER, Daniele RP, Dantzker DR, et al. Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am Rev Respir Dis. 1990;142:481\u20136.","journal-title":"Am Rev Respir Dis"},{"key":"536_CR5","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s40560-020-00469-w","volume":"8","author":"M Kyo","year":"2020","unstructured":"Kyo M, Hosokawa K, Ohshimo S, Kida Y, Tanabe Y, Shime N. Prognosis of pathogen-proven acute respiratory distress syndrome diagnosed from a protocol that includes bronchoalveolar lavage: a retrospective observational study. J Intensive Care. 2020;8:54.","journal-title":"J Intensive Care"},{"key":"536_CR6","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1164\/rccm.201202-0320ST","volume":"185","author":"KC Meyer","year":"2012","unstructured":"Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, du Bois RM, et al. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012;185:1004\u201314.","journal-title":"Am J Respir Crit Care Med"},{"key":"536_CR7","doi-asserted-by":"publisher","first-page":"e97346","DOI":"10.1371\/journal.pone.0097346","volume":"9","author":"SH Choi","year":"2014","unstructured":"Choi SH, Hong SB, Hong HL, Kim SH, Huh JW, Sung H, et al. Usefulness of cellular analysis of bronchoalveolar lavage fluid for predicting the etiology of pneumonia in critically ill patients. Plos One. 2014;9:e97346.","journal-title":"Plos One"},{"key":"536_CR8","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1183\/09031936.93.06091276","volume":"6","author":"M Drent","year":"1993","unstructured":"Drent M, van Velzen-Blad H, Diamant M, Wagenaar SS, Hoogsteden HC, van den Bosch JM. Bronchoalveolar lavage in extrinsic allergic alveolitis: effect of time elapsed since antigen exposure. Eur Respir J. 1993;6:1276\u201381.","journal-title":"Eur Respir J"},{"key":"536_CR9","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1164\/ajrccm\/145.6.1433","volume":"145","author":"JP Lynch 3rd","year":"1992","unstructured":"Lynch JP 3rd, Standiford TJ, Rolfe MW, Kunkel SL, Strieter RM. Neutrophilic alveolitis in idiopathic pulmonary fibrosis. The role of interleukin-8. Am Rev Respir Dis. 1992;145:1433\u20139.","journal-title":"Am Rev Respir Dis"},{"key":"536_CR10","first-page":"35","volume":"135","author":"PL Haslam","year":"1987","unstructured":"Haslam PL, Dewar A, Butchers P, Primett ZS, Newman-Taylor A, Turner-Warwick M. Mast cells, atypical lymphocytes, and neutrophils in bronchoalveolar lavage in extrinsic allergic alveolitis. Comparison with other interstitial lung diseases. Am Rev Respir Dis. 1987;135:35\u201347.","journal-title":"Am Rev Respir Dis"},{"key":"536_CR11","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1378\/chest.07-1948","volume":"133","author":"BW Kinder","year":"2008","unstructured":"Kinder BW, Brown KK, Schwarz MI, Ix JH, Kervitsky A, King TE Jr. Baseline BAL neutrophilia predicts early mortality in idiopathic pulmonary fibrosis. Chest. 2008;133:226\u201332.","journal-title":"Chest"},{"key":"536_CR12","doi-asserted-by":"publisher","first-page":"e36","DOI":"10.1164\/rccm.202005-2032ST","volume":"202","author":"G Raghu","year":"2020","unstructured":"Raghu G, Remy-Jardin M, Ryerson CJ, Myers JL, Kreuter M, Vasakova M, et al. Diagnosis of hypersensitivity pneumonitis in adults. An official ATS\/JRS\/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2020;202:e36\u201369.","journal-title":"Am J Respir Crit Care Med"},{"key":"536_CR13","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1164\/rccm.201807-1255ST","volume":"198","author":"G Raghu","year":"2018","unstructured":"Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS\/ERS\/JRS\/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2018;198:e44\u201368.","journal-title":"Am J Respir Crit Care Med"},{"key":"536_CR14","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12890-017-0412-8","volume":"17","author":"R Takei","year":"2017","unstructured":"Takei R, Arita M, Kumagai S, Ito Y, Noyama M, Tokioka F, et al. Impact of lymphocyte differential count > 15% in BALF on the mortality of patients with acute exacerbation of chronic fibrosing idiopathic interstitial pneumonia. BMC Pulm Med. 2017;17:67.","journal-title":"BMC Pulm Med"},{"key":"536_CR15","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1097\/CCM.0000000000003081","volume":"46","author":"L Gerard","year":"2018","unstructured":"Gerard L, Bidoul T, Castanares-Zapatero D, Wittebole X, Lacroix V, Froidure A, et al. Open lung biopsy in nonresolving acute respiratory distress syndrome commonly identifies corticosteroid-sensitive pathologies, associated with better outcome. Crit Care Med. 2018;46:907\u201314.","journal-title":"Crit Care Med"},{"key":"536_CR16","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1111\/resp.12305","volume":"19","author":"D Papakosta","year":"2014","unstructured":"Papakosta D, Manika K, Gounari E, Kyriazis G, Kontakiotis T, Spyropoulos G, et al. Bronchoalveolar lavage fluid and blood natural killer and natural killer T-like cells in cryptogenic organizing pneumonia. Respirology. 2014;19:748\u201354.","journal-title":"Respirology"},{"key":"536_CR17","doi-asserted-by":"crossref","unstructured":"Traba J, Waldmann TA, Anton OM. Analysis of human natural killer cell metabolism. J Vis Exp. 2020;160.","DOI":"10.3791\/61466"},{"key":"536_CR18","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1001\/jama.2011.1435","volume":"306","author":"TW Rice","year":"2011","unstructured":"Rice TW, Wheeler AP, Thompson BT, DeBoisblanc BP, Steingrub J, Rock P, NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306:1574\u20138.","journal-title":"JAMA"},{"key":"536_CR19","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1001\/jama.2012.137","volume":"307","author":"TW Rice","year":"2012","unstructured":"National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the Eden randomized trial. JAMA. 2012;307:795\u201380.","journal-title":"JAMA"},{"key":"536_CR20","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1164\/rccm.201012-2090OC","volume":"184","author":"MA Matthay","year":"2011","unstructured":"National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, et al. Randomized, placebo-controlled clinical trial of an aerosolized \u03b22-agonist for treatment of acute lung injury. Am J Respir Crit Care Med. 2011;184:561\u20138.","journal-title":"Am J Respir Crit Care Med"},{"key":"536_CR21","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1164\/rccm.201810-2050CP","volume":"200","author":"N Yehya","year":"2019","unstructured":"Yehya N, Harhay MO, Curley MAQ, Schoenfeld DA, Reeder RW. Reappraisal of ventilator-free days in critical care research. Am J Respir Crit Care Med. 2019;200:828\u201336.","journal-title":"Am J Respir Crit Care Med"}],"container-title":["Journal of Intensive Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40560-021-00536-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s40560-021-00536-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40560-021-00536-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,18]],"date-time":"2022-12-18T17:56:07Z","timestamp":1671386167000},"score":1,"resource":{"primary":{"URL":"https:\/\/jintensivecare.biomedcentral.com\/articles\/10.1186\/s40560-021-00536-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,23]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["536"],"URL":"https:\/\/doi.org\/10.1186\/s40560-021-00536-w","relation":{},"ISSN":["2052-0492"],"issn-type":[{"value":"2052-0492","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,23]]},"assertion":[{"value":"15 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All study procedures involving human participants were approved by the Human Ethics Committee of the Graduate School of Medicine, Chiba University (no. 2584).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"21"}}