title: Diffuse alveolar hemorrhage in immunocompetent patients: etiologies and prognosis revisited.
abstract: BACKGROUND
  Diffuse alveolar hemorrhage (DAH) represents a diagnostic challenge of acute respiratory failure. Prompt identification of the underlying cause of DAH and initiation of appropriate treatment are required in order to prevent acute respiratory failure and irreversible loss of renal function. More than 100 causes of DAH have been reported. However, the relative frequency and the differential presentation of those causes have been poorly documented, as well as their respective prognosis.
  
  
  METHODS
  We retrospectively reviewed the charts of 112 consecutive patients hospitalized for DAH in a tertiary referral center over a 30-year period.
  
  
  RESULTS
  Twenty-four causes of DAH were classified into four etiologic groups: immune (n = 39), congestive heart failure (CHF; n = 33), miscellaneous (n = 26), and idiopathic DAH (n = 14). Based on this classification, clinical and laboratory features of DAH differed on hospital admission. Patients with immune DAH had more frequent pulmonary-renal syndrome (p < 0.001), extra-pulmonary symptoms (p < 0.01), and lower blood hemoglobin level than others (p < 0.001). Patients with CHF-related DAH were older and received more anticoagulant treatments than others (p < 0.05). Those with miscellaneous causes of DAH exhibited a shorter prodromal phase (p < 0.001) and had more frequent hemoptysis >200 mL (p < 0.05). Patients with idiopathic DAH had more bronchoalveolar lavage siderophages (p < 0.01). In-hospital mortality was 24.1%, ranging from 7.1% in patients with idiopathic DAH to 36.4% in those with CHF.
  
  
  CONCLUSIONS
  Arbitrary classification of DAH in four etiologic groups gives the opportunity to underline distinct presentations and outcomes of various causes of DAH.
authors.affiliation: Service de Pneumologie et Réanimation and Centre de Compétence des Maladies Rares Pulmonaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Prost
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.forename: Elise
authors.initials: E
authors.lastname: Cuquemelle
authors.forename: Clément
authors.initials: C
authors.lastname: Picard
authors.forename: Martine
authors.initials: M
authors.lastname: Antoine
authors.forename: Joceline
authors.initials: J
authors.lastname: Fleury-Feith
authors.forename: Charles
authors.initials: C
authors.lastname: Mayaud
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
authors.forename: Jacques
authors.initials: J
authors.lastname: Cadranel
mesh_terms: D000328:Adult; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis / Q000378:metabolism; D005260:Female; D005921:Glomerulonephritis / Q000150:complications; D006333:Heart Failure / Q000150:complications; D006470:Hemorrhage / Q000150:complications / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007154:Immune System Diseases / Q000150:complications; D016867:Immunocompromised Host; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000150:complications; D017563:Lung Diseases, Interstitial / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011650:Pulmonary Alveoli; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic