Management of life-threatening haemoptysis in an area of high tuberculosis incidence.
BACKGROUND
Emergency admissions with life-threatening haemoptysis in an area of high tuberculosis (TB) incidence at the University of Stellenbosch and Tygerberg Academic Hospital, South Africa. It is unclear if lung resection is regularly indicated to prevent recurrence following bronchial artery embolisation (BAE).


OBJECTIVE
To prospectively evaluate risk factors for recurrence as selection criteria for surgery following embolisation: lack of complete cessation of haemoptysis, need for blood transfusion, presence of aspergilloma and absence of active TB.


METHODS
Prospective interventional study with 1-year follow-up.


RESULTS
Within a 7-month period, 101 consecutive patients were admitted. Seven were excluded and 12 died shortly after admission. Haemoptysis ceased on medical treatment alone within 24 h in 21 of the remaining 82 patients. Their 1-year mortality was 10%. Eleven of 61 patients referred for emergency embolisation died before discharge. Of the 50 patients remaining at risk of recurrence, 38 (76%) were at low risk and 12 (24%) at high risk. Five of these patients (10% of those at risk) underwent surgery. Patients at low risk and operated patients had an uneventful course over 1 year, but two deaths occurred among the seven inoperable patients at high risk.


CONCLUSIONS
Lung resection surgery following successful BAE for life-threatening haemoptysis can safely be avoided in patients at low risk of recurrence.
Gross
A M
AM
Department of Medicine, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa.
Diacon
Andreas H
AH
van den Heuvel
M M
MM
Janse van Rensburg
J
J
van Rensburg
J
J
Harris
D
D
Bolliger
C T
CT
D000328:Adult; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic; D005260:Female; D006469:Hemoptysis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*