Risk factors for recurrence of haemoptysis following bronchial artery embolisation for life-threatening haemoptysis
Abstract:SETTING: Life-threatening haemoptysis is a frequent and often fatal complication in areas with a high prevalence of tuberculosis (TB). Bronchial artery embolisation remains the standard initial treatment. Subsequent curative measures, such as surgical resection of the focus of haemorrhage, are generally recommended to prevent recurrence, but risk-based selection criteria have not been established.
OBJECTIVES: To identify risk factors for the recurrence of haemoptysis following embolisation.
DESIGN: Baseline characteristics were obtained from consecutive patients with life-threatening haemoptysis who were successfully embolised and followed up for at least 12 months.
RESULTS: Recurrence of haemoptysis was observed in 47% and was associated with increased mortality compared to patients without recurrence (31% vs. 10%, P = 0.021). Patients with recurrence experienced residual mild haemoptysis beyond the first week after embolisation (odds ratio [OR] 7.2), received blood transfusions (OR 5.3) or presented with an aspergilloma (OR 5.1). Conversely, the presence of active TB amenable to treatment (OR 0.3) protected patients from these events. Radiographic or angiographic appearance did not predict recurrence.
CONCLUSIONS: Recurrence of haemoptysis following embolisation for life-threatening haemoptysis is common and is associated with high mortality. The results of this study can contribute to the risk assessment of these patients and guide decisions regarding the urgency of definitive therapy.
Document Type: Regular Paper
Affiliations: 1: Department of Medicine, Tygerberg Academic Hospital and the University of Stellenbosch, Cape Town, South Africa 2: Department of Medical Imaging, Tygerberg Academic Hospital and the University of Stellenbosch, Cape Town, South Africa
Publication date: August 1, 2007
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