Esra ERTAN, Mehmet Akif ÖZGÜL, Selim KAHRAMAN, Veysel YILMAZ, Pınar YILDIZ, Akif TURNA

Risk factors and recurrence patterns in 203 patients with hemoptysis

Hemoptizili hastanın tedavisi, özellikle masif hemoptizi gibi hayatı ciddi olarak tehdit eden durumlarda, hastanın stabilizasyonunu ve ivedi teşhisi gerektirir. Bu retrospektif çalışmada, hemoptizili hastalardaki etyolojilerin dağılımı, fiberoptik bronkoskopi (FOB)’nin bir teşhis aracı olarak yerini, masif hemoptiziyi ve hemoptizi nüksünü tahmin ettirecek potansiyel risk faktörleri irdelendi. Kliniğimize yatırılarak tetkik edilen 181’i erkek, 22’si kadın toplam 203 hemoptizili hasta retrospektif olarak irdelendi. Hemoptizili hastalarda en sık saptanan etyoloji 89 (%43.8) hasta ile tüberküloz iken, bunu 44 (%21.7) hasta ile akciğer kanseri, 11 (%5.5) hasta ile kronik bronşit izledi. Her ne kadar FOB hastaların çoğunda tanı sağlayabildi ise de, 31 (%15.3) hastada herhangi bir endobronşiyal patoloji saptanmadı. Toplam 29 (%14.3) hastada nüks hemoptizi saptandı ve ilk hemoptizinin beş günden fazla sürmesi, ikinci hemoptizinin oluşması için bir risk faktörü olarak belirlendi (p= 0.02). Çoklu değişkenli analiz sonucu, akciğer kanseri varlığı, hemoptizinin tekrarlaması için negatif bir belirleyici olarak bulundu (p= 0.034). Toplam 22 (%10.8) hastada ağır hemoptizi gelişti ve bu olgular medikal olarak tedavi edilebildi. Tüberküloz, akciğer kanseri ve ağır sigara içiciliği, hemoptizi gelişimi açısından bağımsız risk faktörleri olarak belirlendi (p= 0.016, 0.001, 0.041). Hemoptizi, her zaman kanama yerini ve etyolojiyi belirlemek için FOB ile inceleme gerektiren önemli ve sık görülen bir semptomdur. Beş günden fazla süren ve akciğer kanseri nedeniyle oluşan hemoptizi nüks kanamayı işaret eder, daha sık ve yakından takip gerektirir.

Hemoptizili 203 hastada risk faktörleri ve nüks olasılıkları

Management of hemoptysis requires prompt diagnosis and patient stabilization especially in massive hemoptysis as a potentially life-threatening condition. This retrospective study was designed to determine the etiologic distribution of hemoptysis, the role of the fiberoptic bronchoscopy (FOB) as a diagnostic tool, and to clarify potential risk factors for massive hemoptysis and recurrences. A total of 203 patients (181 male, 22 female) with hemoptysis admitted to our hospital were evaluated retrospectively. Tuberculosis was the leading cause of hemoptysis (n= 89; 43.8%) followed by lung cancer (21.7%) and chronic bronchitis (n= 11; 5.5%). FOB plays an essential role for localization of bleeding and diagnosis, although no bronchoscopic abnormality was found in our 31 patients (15.3%). Twenty-nine of the patients (14.3%) had recurrent hemoptysis and hemoptysis lasting longer than five days was found as a risk factor for recurrences (p= 0.02). Having lung cancer was an independent negative risk factor for recurrent hemoptysis using multivariate analysis (n= 44; p= 0.034). Twenty two of the patients (10.8%) had severe hemoptysis and managed medically. In our study, tuberculosis, lung cancer and heavy cigarette smoking were revealed as independent predictors of massive hemoptysis (p= 0.016, 0.001, 0.041 respectively). Hemoptysis is a common respiratory symptom that always requires investigation by using FOB and radiography in order to determine exact site of bleeding and etiology. Hemoptysis continuing more than five days and lung cancer diagnosis may indicate recurrent bleeding and need more attention.

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