Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality

Abstract

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?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 longterm mortality in univariate analysis were age over 60 yrs (p50.026), cardiovascular comorbidity (p50.027) and end-stage renal failure with dependence on haemodialysis (p50.026).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.

Cytoplasmic Anti-Neutrophil Cytoplasmic Antibody Positive Diffuse Alveolar Hemorrhage Associated with Methimazole

“…Some lessons can be learned from our case. First, prompt diagnosis and adequate treatment are crucial factors for the prognosis of life-threatening DAH, as early diagnosis and immediate therapeutic intervention by steroid were instrumental in helping our patient survive DAH [14,15]. Second, clinicians should be alert to the possibility that DAH can occur in patients taking methimazole.…”

Rapidly Progressive Dyspnea after Coronary Arterial Bypass Grafting with Bilateral Internal Mammary Artery: Report of a Case

“…DAH is a syndrome characterised by bleeding into alveolar spaces without inflammation or destruction of the alveolar structures, there by differing from the pulmonary capillaritis type by the lack of systemic vasculitis and connective tissue disorders within a spectrum ranging from asymptomatic radiographic abnormalities to severe life-threatening respiratory failure (1,2) .…”

“…DAH may occur in the context of various systemic disorders or may be present in isolation (2) . The presence of DAH after coronary artery bypass surgery is a rare complication.…”

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

“…In a recent study, de Prost et al reported that the major etiologies of DAH were not immunerelated, such as cardiac dysfunction (8). Although vasculitis is considered to be the main etiology of DAH, the pathophysiology of bland DAH, especially that due to cardiac disorders, should be emphasized.…”

“…Malignant diseases were evaluated according to BALF cytology. The diagnosis of acute exacerbation of interstitial pneumonia was made based on existing criteria (7), and clotting disorders were diagnosed according to a platelet count of <15,000/mL or prothrombin time-international normalized ratio of >1.5, based on a previous report (8). In addition, the diagnosis of drug-induced lung injury was established in cases with a compatible chronology of adverse events following exposure to known pneumotoxic drugs; this diagnosis required the exclusion of other causes.…”