Abstract：
BACKGROUND: Epstein-Barr Virus (EBV) is associated with lung disease in immunocompromised patients, particularly transplant recipients. EBV DNA testing of lower respiratory tract specimens may have diagnostic utility.
METHODS: This was a retrospective, observational study of all patients with bronchoalveolar lavage (BAL) fluids submitted for EBV qPCR testing from February 2016 to June 2022 at the Stanford Clinical Virology Laboratory.
RESULTS: There were 140 patients that underwent 251 EBV qPCR BAL tests (median 1; range 1 - 10). These patients had a mean age of 15.9 years (standard deviation, 15.1 years) and 50 % were female. Transplant recipients accounted for 67.1 % (94/140) of patients, including 67.0 % (63/94) solid organ transplant (SOT) and 33.0 % (31/94) hematopoietic cell transplant. Diagnostic testing was performed more commonly than surveillance testing [57.0 % (143/251) v. 43.0 % (108/251)]; 96.2 % (104/108) of surveillance samples were from lung transplant recipients. Excluding internal control failures, 34.7 % (83/239) of BAL had detectable EBV DNA, encompassing a wide range of viral loads (median=3.03 log10 IU/mL, range 1.44 to 6.06). Overall agreement of EBV DNA in BAL compared to plasma was 74.1 % [117/158; 95 % confidence interval (CI): 66.5 % to 80.7 %], with a kappa coefficient of 0.44 (95 % CI: 0.30 to 0.57). Only 20.1 % (48/239) of results were discussed in a subsequent clinical note, and one result (0.4 %; 1/239) changed clinical management.
CONCLUSIONS: EBV qPCR testing on BAL offers limited clinical impact. Additional biomarkers are required to improve the diagnosis of EBV-associated lung diseases.
METHODS: This was a retrospective, observational study of all patients with bronchoalveolar lavage (BAL) fluids submitted for EBV qPCR testing from February 2016 to June 2022 at the Stanford Clinical Virology Laboratory.
RESULTS: There were 140 patients that underwent 251 EBV qPCR BAL tests (median 1; range 1 - 10). These patients had a mean age of 15.9 years (standard deviation, 15.1 years) and 50 % were female. Transplant recipients accounted for 67.1 % (94/140) of patients, including 67.0 % (63/94) solid organ transplant (SOT) and 33.0 % (31/94) hematopoietic cell transplant. Diagnostic testing was performed more commonly than surveillance testing [57.0 % (143/251) v. 43.0 % (108/251)]; 96.2 % (104/108) of surveillance samples were from lung transplant recipients. Excluding internal control failures, 34.7 % (83/239) of BAL had detectable EBV DNA, encompassing a wide range of viral loads (median=3.03 log10 IU/mL, range 1.44 to 6.06). Overall agreement of EBV DNA in BAL compared to plasma was 74.1 % [117/158; 95 % confidence interval (CI): 66.5 % to 80.7 %], with a kappa coefficient of 0.44 (95 % CI: 0.30 to 0.57). Only 20.1 % (48/239) of results were discussed in a subsequent clinical note, and one result (0.4 %; 1/239) changed clinical management.
CONCLUSIONS: EBV qPCR testing on BAL offers limited clinical impact. Additional biomarkers are required to improve the diagnosis of EBV-associated lung diseases.
摘要：
背景：EB病毒（EBV）与免疫功能低下患者的肺部疾病有关，特别是移植接受者。下呼吸道标本的EBVDNA检测可能具有诊断作用。
方法：这是一个回顾性研究，2016年2月至2022年6月，在斯坦福临床病毒学实验室对所有接受支气管肺泡灌洗（BAL）液进行EBVqPCR检测的患者进行观察性研究。
结果：有140名患者接受了251例EBVqPCRBAL测试（中位数1；范围1-10）。这些患者的平均年龄为15.9岁(标准偏差，15.1岁）和50％为女性。移植受者占患者的67.1%(94/140)，其中67.0%(63/94)实体器官移植(SOT)和33.0%(31/94)造血细胞移植。诊断测试比监测测试更常见[57.0％（143/251）v.43.0％（108/251）];96.2％（104/108）的监测样本来自肺移植受者。不包括内部控制故障，34.7%(83/239)的BAL有可检测的EBVDNA，涵盖广泛的病毒载量(中位数=3.03log10IU/mL，范围为1.44至6.06）。与血浆相比，BAL中EBVDNA的总体一致性为74.1％[117/158;95％置信区间（CI）：66.5％至80.7％]，卡帕系数为0.44(95%CI：0.30至0.57)。在随后的临床记录中只讨论了20.1%(48/239)的结果，一项结果（0.4％；1/239）改变了临床管理。
结论：EBVqPCR检测对BAL的临床影响有限。需要额外的生物标志物来改善EBV相关肺部疾病的诊断。
方法：这是一个回顾性研究，2016年2月至2022年6月，在斯坦福临床病毒学实验室对所有接受支气管肺泡灌洗（BAL）液进行EBVqPCR检测的患者进行观察性研究。
结果：有140名患者接受了251例EBVqPCRBAL测试（中位数1；范围1-10）。这些患者的平均年龄为15.9岁(标准偏差，15.1岁）和50％为女性。移植受者占患者的67.1%(94/140)，其中67.0%(63/94)实体器官移植(SOT)和33.0%(31/94)造血细胞移植。诊断测试比监测测试更常见[57.0％（143/251）v.43.0％（108/251）];96.2％（104/108）的监测样本来自肺移植受者。不包括内部控制故障，34.7%(83/239)的BAL有可检测的EBVDNA，涵盖广泛的病毒载量(中位数=3.03log10IU/mL，范围为1.44至6.06）。与血浆相比，BAL中EBVDNA的总体一致性为74.1％[117/158;95％置信区间（CI）：66.5％至80.7％]，卡帕系数为0.44(95%CI：0.30至0.57)。在随后的临床记录中只讨论了20.1%(48/239)的结果，一项结果（0.4％；1/239）改变了临床管理。
结论：EBVqPCR检测对BAL的临床影响有限。需要额外的生物标志物来改善EBV相关肺部疾病的诊断。
