Long-term prognostic outcomes in patients with haemoptysis

Abstract

Background Haemoptysis is a challenging symptom that can be associated with potentially life-threatening medical conditions. Follow-up is key in these patients to promptly detect new or misdiagnosed pathologic findings. Few prospective studies have evaluated long-term prognostic outcomes in patients with haemoptysis. Furthermore, the role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear. The aim of this study was to assess mortality after 18 months of follow-up. Furthermore, the incidence of recurrence and the risk factors for recurrence and death were evaluated (including the role played by anticoagulant and antiplatelet drugs). Methods Observational, prospective, multicentre, Italian study. Results 451/606 (74.4%) recruited patients with haemoptysis 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 haemoptysis 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 haemoptysis followed-up for 18 months. Pulmonary malignancy was the main aetiology and the main predictor of death, whereas bronchiectasis was the most frequent diagnosis associated with recurrence. Antiplatelet and/or anticoagulant therapy did not change the risk of death or recurrence. Follow-up is recommended in patients initially diagnosed with lower airways infections and idiopathic bleeding. Trial registration: NCT02045394

Hemoptysis in adult patients: Etiology, recurrence and risk of mortality

“…In our study, the most common recurrence risk was seen in patients with lung cancer diagnosis and use of anticoagulant/antiaggregant. In a study evaluating long-term prognostic outcomes in patients with hemoptysis, bronchiectasis was found to be associated with an increased risk of recurrence (19). Fidan et al and Ryuge et al also found bronchiectasis to be the most common diagnosis in recurrent hemoptysis (6,20).…”

“…However, in the correlation analysis, only the length of stay in the first hemoptysis was found to be associated with mortality. Mondoni et al reported that the overall mortality rate was 13.7%, increased from 18.1% to 31% after a one-year follow-up, and lung malignancy was the main determinant of mortality (19). Mortality rates are 50-100% in patients with massive hemoptysis treated conservatively (1).…”

Life-Threatening Hemoptysis From Aorto-Bronchial Fistula in a Patient With Remote History of Aortic Coarctation Repair

“…A 2006 cohort study in Paris of 1087 individuals identified the most common causes of major hemoptysis as bronchitis (20%), cryptogenic (18%), cancer (17%), active tuberculosis (12%), and tuberculosis sequelae (13%) [ 2 ]. A report in 2018 of 606 patients with hemoptysis, showed malignancy (19%), pneumonia/lung abscess (19%), and bronchiectasis (15%) as the most common causes [ 3 ]. The cause of hemoptysis in our patient is exceedingly rare.…”

Pseudomonas aeruginosa isolation is an important predictor for recurrent hemoptysis after bronchial artery embolization in patients with idiopathic bronchiectasis: a multicenter cohort study

“…The United States Bronchiectasis Research Registry reported that 23% of patients with bronchiectasis had a history of hemoptysis [ 1 ]. The hemoptysis volume was larger than other diseases with more cases leading to recurrence [ 6 ]. In-hospital death rates due to hemoptysis among adults with bronchiectasis occurred in approximately 4.5–9.2% of hospitalizations [ 7 , 8 ].…”