Chest
Volume 98, Issue 3, September 1990, Pages 560-567
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Clinical Investigations
Predictive Value of Bronchoalveolar Lavage in Pulmonary Sarcoidosis

https://doi.org/10.1378/chest.98.3.560Get rights and content

We investigated whether analysis of cellular composition (including lymphocyte subsets) in bronchoalveolar lavage (BAL) fluid at the start of follow-up in patients with untreated sarcoidosis has any predictive value for further evolution of the disease. The outcome was evaluated by the chest roentgenograms, the lung volumes, and the single breath diffusing capacity for CO (Dco) after 22 to 36 months. In contrast to the general belief, patients who improved radiologically had a significantly higher T4 cell count (as percentage of BAL lymphocytes) (p<0.02) and a higher T4-T8 ratio in the initial BAL sample (9.3 vs 3.2; p<0.05) than those whose chest roentgenogram showed deterioration or remained unchanged. Total cell count and the percentage of lymphocytes in BAL fluid were not different between both groups. The change in Dco at the end of the follow-up period correlated positively with the baseline BAL T4 cells (Rs = 0.44; p<0.05) and with the BAL T4-T8 ratio (Rs = 0.51; p<0.03) and negatively with the baseline BAL T8 cells (Rs= –0.48; p<0.04). In only three patients progression of the disease necessitated steroid therapy, and they all had a low to normal T4-T8 ratio in the initial BAL sample. Bronchoalveolar lavage was repeated at least once in ten patients. Improvement of the chest roentgenograms in these patients was accompanied by a decrease of the BAL T4 cell count (as percentage of lymphocytes) and of the T4-T8 ratio. We conclude that a high lymphocyte count, a high T4 cell count (as percentage of lymphocytes), and a high T4-T8 ratio in BAL fluid reflect an intense alveolitis at the time of the procedure, but they are not indicators of poor prognosis on which therapeutic decisions can be based.

Section snippets

Subjects

Fifty-nine consecutive patients with untreated pulmonary sarcoidosis underwent BAL as a diagnostic procedure between December 1981 and February 1987. Of these patients, 23 were not available for follow-up and five were excluded from this study because corticosteroid therapy was started immediately after the BAL. Thirty-one patients (20 women, 11 men) were followed up for a period of 22 to 81 months (median, 43 months).

The diagnosis of pulmonary sarcoidosis satisfied the following three

Initial Disease Activity Indices and Radiologic Stage

In Table 1, the patient population under study is presented. The results of the BAL cellular composition and the SACE level are given according to the radiologic stage at the start of follow-up. There was a significantly lower lymphocyte count in stage III patients vs stage I and II patients. The T4-T8 ratio was highest in stage I disease and correlated negatively with the radiologic stage (Rs = –0.45; p<0.02). Moreover, the proportion of T8 cells (expressed as percentage of lymphocytes)

DISCUSSION

In this article, we report that in patients with untreated sarcoidosis, the total cell count and the lymphocyte cell count in the BAL fluid are not predictive of the evolution of the disease. A high T4 cell count or a high T4-T8 ratio in the BAL seem to be indicators of a good prognosis. Patients who improved radiologically had a significantly higher T4 cell count (as percentage of lymphocytes) and a significantly higher T4-T8 ratio in the initial BAL; also, the evolution of the Dco correlated

ACKNOWLEDGMENTS

We want to thank Mariette Roozenkrans and Lisette Meurs for technical help in the analysis of BAL samples, and Heidi Verheyden for typing the manuscript.

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    Manuscript received November 27; revision accepted February 16.

    Reprint requests: Dr. Ceuppens, Lab Klinische Immunologie·, Universitair Ziekenhuis, 3000 Leuven, Belgium

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