Abstract
BackgroundHaemoptysis 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).MethodsObservational, prospective, multicentre, Italian study.Results451/606 (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.ConclusionsOur 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
Highlights
Haemoptysis is a challenging symptom that can be associated with potentially life-threatening medical conditions
Lung cancers and bronchiectasis were subsequently diagnosed in patients with an initial diagnosis of idiopathic haemoptysis and lower respiratory tract infection [2, 10]
Death was the outcome of the disease which caused haemoptysis at baseline in 52/83 (62.7%) patients: 42 died due to lung cancer, seven patients for metastatic pulmonary malignancy, two patients for pneumonia, and one for a bronchiectasis exacerbation
Summary
Haemoptysis is a challenging symptom that can be associated with potentially life-threatening medical conditions. The role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear. Lung cancers and bronchiectasis were subsequently diagnosed in patients with an initial diagnosis of idiopathic haemoptysis and lower respiratory tract infection [2, 10]. In this context, follow-up is key to detecting new or misdiagnosed pathologic findings (e.g., lung malignancy) [2, 6, 8]. Few prospective studies have evaluated the survival rate, the mortality-related risk factors, or the incidence of recurrence and its associated variables [7, 8]. The role played by antiplatelet and anticoagulant drugs is still unclear
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