Long-term Prognostic Outcomes in Patients With Hemoptysis

Abstract

Background: Hemoptysis is a challenging symptom which can be associated with potentially life-threatening medical conditions. Follow-up is key in these patients to early detect new or misdiagnosed pathologic findings. Few prospective studies evaluated long-term prognostic outcomes. Furthermore, the role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear.The aim of the study was to assess the mortality after 18 months of follow-up; furthermore, it was evaluated the incidence of recurrences and the factors associated with both recurrence and death (including the role played by anticoagulant and antiplatelet drugs).Methods: Observational, prospective, multicentre, Italian study.Results: 451/606 (74.4%) recruited patients with hemoptysis completed the 18 months follow-up.22/604 (3.6%) diagnoses changed from baseline to the end of the follow-up. 83/604 (13.7%) patients died. In 52/83 (62.7%) patients, death was the outcome of the disease which caused hemoptysis at baseline. Only the diagnosis of lung neoplasm was associated with death (OR (95%CI): 38.2 (4.2-347.5); p-value: 0.0001).166 recurrences were recorded in 103/604 (17%) patients. The diagnosis of bronchiectasis was significantly associated with the occurrence of a recurrence (OR (95% CI): 2.6 (1.5-4.3)); p-value <0.0001).Anticoagulant, antiaggregant, and anticoagulant plus antiaggregant drugs were not associated with an increased risk of death and recurrence.Conclusions: Our study showed a low mortality rate in patients with hemoptysis followed-up for 18 months. Pulmonary malignancy is the main etiology and the main predictor of death, whereas bronchiectasis is the most frequent diagnosis associated with recurrence. Antiplatelet and/or anticoagulant therapy do not change the risk of death or recurrence. Follow-up is recommended in patients initially diagnosed with lower airways infections and idiopathic bleedings.Clinical trial registration: NCT02045394.