Alveolar Haemorrhage in the Immunocompetent Host: A Scale for Early Diagnosis of an Immune Cause

Abstract

Background: Diffuse alveolar haemorrhage (DAH) is a life-threatening condition due to immune and non-immune causes. Early identification of an underlying immune disorder is essential in order to initiate appropriate treatment. Objective: The purpose of this study was to identify early predictive factors of an immune cause of DAH. Methods: We conducted a retrospective study of 76 immunocompetent patients with DAH to identify early predictive factors of immune-related DAH using clinical, radiological and routine biological data available in the first 24 h after hospital admission. Results: Multivariate analysis identified 4 parameters which were independently associated with immune-related DAH: (1) onset of first respiratory symptoms ≧11 days, (2) fatigue and/or weight loss during the month prior to presentation, (3) arthralgias or arthritis and (4) proteinuria ≧1 g/l. A simplified scale was constructed using these variables, with an area under the receiver operating characteristic curve of 0.913, for the diagnosis of immune-related DAH. Conclusions: A simple diagnostic scale can be used to identify an immune-related cause of DAH in immunocompetent patients and may help guide treatment decisions such as initiation of steroid therapy on the day of admission.

Diffuse alveolar hemorrhage after use of a fluoropolymer-based waterproofing spray

“…Diffuse alveolar hemorrhage (DAH) is a rare, but serious manifestation of acute lung injury (Fukui et al 2011). DAH in this patient was unlikely to be due to immune causes such as microscopic polyangiitis, systemic lupus erythematosus or Goodpasture’s syndrome, because of the absence of weight loss, arthralgia, proteinuria, hematuria, anti-nuclear antibody, anti–anti-GBM antibody or ANCA (Picard et al 2010). Furthermore, neither congestive heart failure nor coagulopathy could be considered as the likely cause of the DAH, because the serum BNP level and coagulation profile were normal.…”

“…The toxicity of waterproofing sprays is thought to be due to their content of water-repellents, such as fluoropolymers and silicon polymers, or of the solvent in which they are delivered (Picard et al 2010). Among different repelling agents, fluoropolymers have been the most studied with regard to their toxicity following inhalation (Hays and Spiller 2014).…”

Alveolar hemorrhagic syndrome in children

“…продемонстрировано, что предикторами иммунной природы альвеолярного геморрагического синдрома у иммунологически состоятельных больных являют-ся: время от первых симптомов болезни до появления альвеолярного геморрагического синдрома -11 сут и более, утомляемость и/или потеря массы тела более 5% в течение 1 мес, артралгии/артриты; протеинурия более 1 г/л [18].…”

Diffuse alveolar hemorrhage

“…In a study of 97 patients with DAH, four parameters suggested immune-related DAH: onset of respiratory symptoms ≥ 11 days, fatigue and/or weight loss during the month prior to presentation, arthralgia or arthritis, and proteinuria ≥ 1 g/L. 7 Vasculitis, mainly granulomatosis with polyangiitis, was the most common cause of DAH in a retrospective study. 8 SLE is the most common connective tissue diseases associated with DAH, and most cases are associated with lupus nephritis.…”