Chest
Volume 128, Issue 2, August 2005, Pages 729-738
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Clinical Investigation
Massive Hemoptysis in Cystic Fibrosis

https://doi.org/10.1378/chest.128.2.729Get rights and content

Background

Massive hemoptysis is a complication commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF

Objectives

To identify risk factors associated with massive hemoptysis, and to determine the prognosis of patients following an episode of massive hemoptysis

Design

A retrospective, observational cohort study of the National CF Patient Registry between the years 1990 to 1999

Patients

The Registry contained data on 28,858 patients with CF observed over 10 years at CF centers across the United States

Results

Massive hemoptysis occurred with an average annual incidence of 0.87% and in 4.1% of patients overall. There was no increased occurrence by sex, but it was more prevalent in older patients (mean age, 24.2 ± 8.7 years [± SD]) with more severe pulmonary impairment (nearly 60% of patients who had an episode of massive hemoptysis had FEV1< 40% predicted). The principal risks associated with an increased occurrence of massive hemoptysis included the presence ofStaphylococcus aureusin sputum cultures (odds ratio [OR], 1.3) and diabetes (OR, 1.1). There was an increased morbidity (eg, increased hospitalizations and hospital days) and an increased 2-year mortality following massive hemoptysis

Conclusion

Massive hemoptysis is a serious complication in CF patients, occurring more commonly in older patients with more advanced lung disease. Nearly 1 in 100 patients will have this complication each year. There is an attributable mortality to the complication and considerable morbidity, resulting in increased health-care utilization and a measurable decline in lung function

Section snippets

Materials and Methods

The CFF supports and accredits CF care centers nationwide. These centers provide specialized care for persons with CF and offer comprehensive diagnosis and treatment, as well as participation in clinical trials of experimental therapies. The CFF Patient Registry contains data on patients with CF seen at one of the accredited CF care centers in the United States. This represents approximately 90% of all CF patients in the United States. The CFF has sponsored the patient registry since 1966 and

Results

There were 1,153 patients (4.1% of the total population) who had at least one episode of massive hemoptysis. Sixteen of these patients did not have a date recorded for their single episode of massive hemoptysis and are not included in all analyses. There were a total of 1,606 entries with massive hemoptysis as a complication; 15 of these entries did not have dates and are not included in some analyses. Most patients had only one recorded event (n = 858), although many had more than one reported

Discussion

Hemoptysis is common for patients with CF, although typically the bleeding is scant or mild. Massive hemoptysis occurs frequently in patients with CF as well. In this analysis of 10 years of data, collected from a large population of patients with CF, we found that 4.1% of patients overall had at least one episode of massive hemoptysis. In addition, there is a high risk of subsequent episodes of massive hemoptysis. Nearly 26% of patients had more than one occurrence. The database only takes

Acknowledgments

The authors are grateful to Dr. Preston Campbell and Dr. Bruce Marshall for editorial assistance.

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  • Cited by (0)

    This work was supported in part by a grant from the Cystic Fibrosis Foundation.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)

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