Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality.
Diffuse alveolar haemorrhage (DAH) is a feature of several immune and nonimmune disorders. Reported prognosis is poor, with in-hospital mortality ranging from 20% to 100%. Early identification of prognostic factors may be useful in the initiation of appropriate treatment. We retrospectively analysed the charts of all patients referred to a university hospital for DAH between 1980 and 2008. Variables associated with in-hospital and long-term mortality were determined using a logistic regression model and the Kaplan-Meier method, respectively. Immunosuppressed patients were excluded. Overall, 97 patients were included in the study. In-hospital mortality was 24.7%. Factors associated with in-hospital mortality were shock (OR 77.5, 95% CI 8.9-677.2), glomerular filtration rate <60 mL x min(-1) (OR 11.2, 95% CI 1.8-68.4) and plasmatic lactate dehydrogenase level more than twice the normal value (OR 12.1, 95% CI 1.7-84.3). Mortality among discharged patients was 16.4% with a median follow-up duration of 34 months. Factors associated with increased long-term mortality in univariate analysis were age over 60 yrs (p = 0.026), cardiovascular comorbidity (p = 0.027) and end-stage renal failure with dependence on haemodialysis (p = 0.026). Patients with immune and nonimmune DAH had similar outcomes. Early outcome depended on nonpulmonary organ failures. Conversely, late outcome was related to age, cardiac comorbidities and the need for haemodialysis.
Service de Pneumologie et Réanimation and Centre de Compétence sur les Maladies Rares Pulmonaires, Paris, France.
N
N
de Prost
A
A
Parrot
C
C
Picard
P-Y
PY
Ancel
C
C
Mayaud
M
M
Fartoukh
J
J
Cadranel
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality; D007297:Inpatients / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008171:Lung Diseases / Q000401:mortality*; D017563:Lung Diseases, Interstitial / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011650:Pulmonary Alveoli / Q000098:blood supply*; D006435:Renal Dialysis / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000401:mortality; D012189:Retrospective Studies