Abstract
BackgroundHemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage.Methods We conducted a retrospective cohort study of 643 consecutive adults with lung cancer over an approximately 4-year period (from January 2014 to February 2018) at a large tertiary care hospital. Patients were divided into the hemorrhage group and the non-hemorrhage group based on endobronchial biopsy (EBB) findings. The association between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), PP to DP ratio (PP/DP) and the risk of EBB-induced hemorrhage was evaluated using multivariate regression analysis and smooth curve fitting adjusted for potential confounding factors.ResultsThe EBB-induced bleeding incidence was 37.8% (243/643) in our cohort. An independent association was found between PP/PD and the EBB-induced hemorrhage risk (per 1 SD, adjusted odds ratio, 0.788; 95% confidence interval, 0.653-0.951). The multivariate regression analysis performed using quartiles of PP/DP revealed that lower level of PP/DP ratio was related to a higher risk of EBB-induced hemorrhage (P for trend <0.05) after adjustment for potential confounders. However, no association was observed between SP, DP, MAP, PP and EBB-induced hemorrhage.ConclusionsLow PP/DP was the independent risk factor for biopsy-induced endobronchial hemorrhage during bronchoscopy in patients with lung cancer.
Highlights
Endobronchial biopsies (EBBs) are widely used in histopathological diagnosis of airway disorders [1]
The relationships between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP) and EBB-induced hemorrhage risk in smooth curve fitting are shown in Fig. 1a–c after adjustment for potential confounders
In the present study, we found that pulse pressure (PP)/DP ratio was associated with EBB-induced hemorrhage risk during bronchoscopy in patients with lung cancer
Summary
Endobronchial biopsies (EBBs) are widely used in histopathological diagnosis of airway disorders [1]. Patients with lung cancer are the main population who is subjected to bronchoscopy and EBBs. hemorrhage is the most frequent and most challenging complication to handle during EBB and intraoperative hypoxemia due to increased blood loss can be life-threatening [2,3,4]. Several hemorrhage risk factors during EBBs have been proposed by previous studies [5, 6], including immunosuppression, mechanical ventilation, thrombocytopenia, anti-coagulant or anti-platelet therapy, severe liver and kidney disease, heart failure, pulmonary arterial hypertension, and lung transplant. Severe hypertension (defined as systolic pressure (SP) >200 mm Hg and/ or diastolic pressure (DP) >110 mm Hg) is considered a contraindication for bronchoscopy [7], it is still unclear whether blood pressure (BP) affects biopsy-induced hemorrhage. Several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage
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