[Effects of diagnostic protocols on etiology and outcome in immunocompromised host with pulmonary infiltrate].

Objective: To explore the effects of diagnostic protocols on etiology and outcome in immunocompromised host (ICH) with pulmonary infiltrate.

Methods: For this historic control study, ICH with acute respiratory failure (ARF) were eligible as study group (n = 65) in 2009 while another ICH cohort was selected as control group (n = 45) in 2007. The protocol consisted of four parts: judgment possible site, determining probable etiology, checking and feedbacks on laboratory test in 12 hours and reassessment and adjustment treatment in 48-72 hours. The etiologies included infection, non-infection and unknown causes.

Results: Their average age was 45.3 years (range: 22 - 71). Causes of immune suppression were autoimmune disease (n = 69), hematological disorders (n = 21), solid cancers (n = 10) and others (n = 10). When two groups were compared, basic diseases, organ function and disease severity showed no significant difference, but etiologic diagnoses rate (73.8% vs 57.8%), time from ICU admission to diagnosis (4.0 vs 6.8 days) and 28-day mortality (38.5% vs 62.2%) had significant difference (P < 0.05).

Conclusion: Implementation of clinical protocol in ICH with ARF is associated with improved etiologic diagnoses and decreased mortality.