Long-term outcomes and prognostic factors in patients with mild hemoptysis

Objective: The aim of this retrospective study was to observe the long-term outcomes of conservative treatment and bronchial artery embolization (BAE) in patients with mild hemoptysis and to analyze the risk factors associated with hemoptysis recurrence. Methods: Patients with mild hemoptysis from January 2005 to January 2016 were enrolled in this study. The patients’ medical records, including smoking history, etiologic diseases, bronchoscopic findings, mortality, BAE information, and follow-up data of recurrent hemoptysis, were reviewed and analyzed. Results: A total of 288 patients with mild hemoptysis were included in this study. Of them, 71 patients (24.7%) underwent BAE and 217 patients (75.3%) were treated conservatively. The clinical success rate of BAE was 98.6%, with a low minor complication rate of 5.6%. Bronchoscopy before treatments was performed in 237 patients (82.3%). Fifty-five patients (19.1%) experienced recurrent hemoptysis during a median follow-up period of 2.4 years (interquartile range: 1.0–4.4 years). Patients who showed active bleeding or blood clots on bronchoscopy had a significantly lower recurrence-free survival rate than patients with no bronchoscopic evidence of bleeding or blood clots (p = 0.012). The risk factors affecting recurrence were heavy smoking (p = 0.002, hazard ratio [HR]: 3.57), aspergillosis (p = 0.035, HR: 6.01), and bronchoscopic findings of active bleeding (p = 0.016, HR: 3.29) or blood clots (p = 0.012, HR: 2.77). Conclusions: The recurrence rate of hemoptysis was not negligible in patients with mild hemoptysis. BAE can be considered in patients with a high risk of recurrence.