PURPOSE: Large series examining etiologies of hemoptysis are lacking in the modern era. The purpose of this study is to describe the causes, outcomes, and factors associated with hemoptysis in adult patients admitted to a medical intensive care unit (MICU) at a large academic center.
METHODS: We performed a retrospective review of all patients diagnosed with hemoptysis between 2001 and 2008 at our institution. We excluded pediatrics and admissions to non-ICU locations. Cause of hemoptysis, need and duration of mechanical ventilation (MV), MICU and hospital length of stay (LOS), MICU and hospital mortality rates were calculated. We used the Social Security Death Index to identify the date of death.
RESULTS: We reviewed 200 records for which 78 subjects met our inclusion criteria. The most common causes of hemoptysis were lung cancer (24.3%), bacterial pneumonia (20.4%), vasculitis (15.2%), undetermined (7.6%), and excessive anticoagulation (6.4%). 76.9% of subjects required MV for which the mean duration of MV was 8.2 days (1-42 days).The mean MICU LOS was 7.7 days (1-42 days) and hospital LOS was 12.3 days (1-65 days). 32% of subjects died in the MICU. The overall hospital mortality rate was 38.4%. Of survivors, 30.7% died within the time period studied. Of these, 65.2% died within the first year. The median survival after discharge was 15.2 months (0.5-61 months).
CONCLUSION: In the last 10 years, the most common etiologies of hemoptysis in critically ill patients include malignancies, infections, and vasculitis. ICU mortality, LOS, and need for MV are significantly elevated in this population. These results differ from studies published in the last 30 years where the main causes of hemoptysis included tuberculosis, bronchiectasis and lung abscess.
CLINICAL IMPLICATIONS: Clinicians should be mindful that frequent causes of hemoptysis in modern ICUs are non-infectious. Overall, hemoptysis requiring ICU admission is associated with high mortality and poor outcomes.
DISCLOSURE: Francisco Flores Guardado, No Financial Disclosure Information; No Product/Research Disclosure Information