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Severe Hemoptysis Associated with Bacterial Pulmonary Infection: Clinical Features, Significance of Parenchymal Necrosis, and Outcome

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Abstract

Purpose

Severe hemoptysis (SH) associated with non-tuberculosis bacterial lower respiratory tract infection (LRTI) is poorly described, and the efficacy of the usual decision-making process is unknown. This study aimed at describing the clinical, radiological patterns, mechanism, and microbiological spectrum of SH related to bacterial LRTI, and assessing whether the severity of hemoptysis and the results of usual therapeutic strategy are influenced by the presence of parenchymal necrosis.

Methods

A single-center analysis of patients with SH related to bacterial LRTI from a prospective registry of consecutive patients with SH admitted to the intensive care unit of a tertiary referral center between November 1996 and May 2013.

Results

Of 1504 patients with SH during the study period, 65 (4.3%) had SH related to bacterial LRTI, including non-necrotizing infections (n = 31), necrotizing pneumonia (n = 23), pulmonary abscess (n = 10), and excavated nodule (n = 1). The presence of parenchymal necrosis (n = 34, 52%) was associated with a more abundant bleeding (volume: 200 ml [70–300] vs. 80 ml [30–170]; p = 0.01) and a more frequent need for endovascular procedure (26/34; 76% vs. 9/31; 29%; p < 0.001). Additionally, in case of parenchymal necrosis, the pulmonary artery vasculature was involved in 16 patients (47%), and the failure rate of endovascular treatment was up to 25% despite multiple procedures.

Conclusions

Bacterial LRTI is a rare cause of SH. The presence of parenchymal necrosis is more likely associated with bleeding severity, pulmonary vasculature involvement, and endovascular treatment failure.

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, CHU Henri Mondor, 94010, Paris, Créteil, France

    Guillaume Carteaux

  2. Faculté de Médecine de Créteil, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, 94010, Paris, Créteil, France

    Guillaume Carteaux, Guillaume Voiriot & Muriel Fartoukh

  3. Service de reanimation polyvalente, Centre Hospitalier d’Argenteuil, 69 rue du Lieutenant-colonel Prud’hon, 95107, Paris, Argenteuil, France

    Damien Contou

  4. Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l’Est Parisien, Hôpital Tenon, 4 rue de la Chine, 75970, Paris, Cedex 20, France

    Guillaume Voiriot, Marie-France Carette, Antoine Parrot & Muriel Fartoukh

  5. Assistance Publique-Hôpitaux de Paris, Service d’Imagerie Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l’Est Parisien, Hôpital Tenon, 75970, Paris, France

    Antoine Khalil

  6. Assistance Publique-Hôpitaux de Paris, Service d’Imagerie Médicale, Hôpital Bichat-Claude-Bernard, 46, rue Henri Huchard, 75018, Paris, France

    Antoine Khalil

  7. Université Paris 07, 75205, Paris, Cedex 13, France

    Antoine Khalil

  8. Sorbonne Universités, UPMC Université Paris 06, Paris, France

    Marie-France Carette, Martine Antoine & Muriel Fartoukh

  9. Assistance Publique-Hôpitaux de Paris, Service d’anatomopathologie, Groupe Hospitalier des Hôpitaux Universitaires de l’Est Parisien, Hôpital Tenon, 75970, Paris, France

    Martine Antoine

Authors
  1. Guillaume Carteaux
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  2. Damien Contou
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  3. Guillaume Voiriot
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  4. Antoine Khalil
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  5. Marie-France Carette
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  7. Antoine Parrot
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  8. Muriel Fartoukh
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Correspondence to Guillaume Carteaux.

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Carteaux, G., Contou, D., Voiriot, G. et al. Severe Hemoptysis Associated with Bacterial Pulmonary Infection: Clinical Features, Significance of Parenchymal Necrosis, and Outcome. Lung 196, 33–42 (2018). https://doi.org/10.1007/s00408-017-0064-8

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  • DOI: https://doi.org/10.1007/s00408-017-0064-8

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