Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database

Abstract

Haemoptysis is a serious symptom with various aetiologies. Our aim was to define the aetiologies, outcomes and associations with lung cancer in the entire population of a high-income country.This retrospective multicentre study was based on the French nationwide hospital medical information database collected over 5 years (2008)(2009)(2010)(2011)(2012). We analysed haemoptysis incidence, aetiologies, geographical and seasonal distribution and mortality. We studied recurrence, association with lung cancer and mortality in a 3-year follow-up analysis.Each year, ∼15 000 adult patients (mean age 62 years, male/female ratio 2/1) were admitted for haemoptysis or had haemoptysis as a complication of their hospital stay, representing 0.2% of all hospitalised patients. Haemoptysis was cryptogenic in 50% of cases. The main aetiologies were respiratory infections (22%), lung cancer (17.4%), bronchiectasis (6.8%), pulmonary oedema (4.2%), anticoagulants (3.5%), tuberculosis (2.7%), pulmonary embolism (2.6%) and aspergillosis (1.1%). Among incident cases, the 3-year recurrence rate was 16.3%. Of the initial cryptogenic haemoptysis patients, 4% were diagnosed with lung cancer within 3 years. Mortality rates during the first stay and at 1 and 3 years were 9.2%, 21.6% and 27%, respectively. This is the first epidemiological study analysing haemoptysis and its outcomes in an entire population. Haemoptysis is a life-threatening symptom unveiling potentially life-threatening underlying conditions. @ERSpublications Haemoptysis is ominous: there is often no clear aetiology and 4% of patients develop lung cancer during follow-up

Haemoptysis: a frequent diagnostic challenge

“…This hypothesis is in accordance with previously published studies [4]. Despite these unavoidable biases and possible inaccuracies due to the coding system, we believe that our 5-year study provided unequivocal and important data regarding the 10 million patients who are hospitalised yearly in France, among whom 15 000 (0.2%) were admitted for haemoptysis or have haemoptysis as a complication of their hospital stay [1]. We provided important information regarding prognosis and follow-up.…”

“…However, we were aware of this possible bias and considered that lung cancer was the aetiology of the initial haemoptysis episode when it was diagnosed within 2 months of the initial haemoptysis. We therefore discussed the hypothesis that lung cancer developed in 4% of patients with initial cryptogenic haemoptysis during the 3 years of follow-up [1]. This hypothesis is in accordance with previously published studies [4].…”

“…Indeed, the 3-year in-hospital mortality rate, excluding lung cancers, was high at 20%. Even if death may have been more closely related to the underlying disease than to haemoptysis itself, these results must be taken into account and suggest that follow-up after the initial haemoptysis needs to be sustained [1].…”

“…We acknowledged that our observational retrospective study had some limitations and possible bias due to the way data was collected, that is to say through hospital discharge diagnosis codes [1]. However, the national administrative database (PMSI/medicalisation of information system programme) has gathered national administrative health data in France from every french public and private teaching and nonteaching healthcare facility since 1997.…”

“…We believe our results bring important and, until now, unknown information about high-income countries. We feel that the association of large retrospective but comprehensive cohort studies [1] and smaller but prospective [6] studies will help to better characterise this ominous symptom. Lung function defects in treated pulmonary tuberculosis patients…”