P-2218. Evaluating the Timing of Bronchoscopy and Plasma Microbial Cell-Free DNA (mcfDNA) Sequencing on Diagnostic Yield: A Secondary Analysis of the Pneumonia in the ImmunoCompromised – use of the Karius Test for detection of Undiagnosed Pathogens (PICKUP) Study
Abstract
Abstract Background Delayed bronchoscopy has been associated with reduced diagnostic yield in immunocompromised patients with pneumonia. We sought to evaluate whether timing of bronchoscopy was associated with diagnostic yield, and if timing of plasma mcfDNA sequencing impacted additive diagnostic value, among patients enrolled in the PICKUP study (NCT04047719). Methods The PICKUP study prospectively enrolled immunocompromised patients undergoing bronchoscopy to identify pneumonia etiology across ten US sites to establish whether plasma mcfDNA increased diagnostic yield compared to usual care. In this secondary analysis, pneumonia onset was defined as the first abnormal chest imaging associated with the index pneumonia event. Diagnostic yield and additive diagnostic value, defined as the patients with a probable cause of pneumonia exclusively identified by plasma mcfDNA sequencing, for those undergoing early (≤5 days from pneumonia onset) versus late ( >5 days) bronchoscopy was evaluated. Results Of the 222 eligible patients enrolled between 01/2020 - 02/2022, we included patients from the first five sites in this preliminary analysis (n=135). Among the five included sites in this analysis, median time from pneumonia onset to bronchoscopy was 4.0 (IQR 9.0) days (Table 1). There was variability in diagnostic yield of usual care between the sites (range 20.0% - 61.5%). Usual care diagnostic yield was 26/88 (30%) for patients undergoing early and 18/47 (38%) for late…
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Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 222 participants or records.
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