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Risk factors of severe hemoptysis in patients with fungus ball
Tae Hoon Kim1, Hyun Jung Koo2, Chae-Man Lim3
1Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
Background:
Hemoptysis is one of the most important complications associated with fungus ball. However, the association of the primary size of the fungus ball and its change with the incidence of hemoptysis was not fully established. This study aims to determine the clinical risk factors of severe hemoptysis and natural course of fungus ball.
Methods:
A retrospective study on patients with fungus ball was performed. Patients with severe hemoptysis-related events were compared to those without events, and the predictors for severe hemoptysis were investigated by Cox regression analysis. Three subgroups (decreased, stable, and increased) were classified according to the long-term size change, and the severe hemoptysis-free survival duration was analyzed by the Kaplan-Meier survival curve.
Results:
Among 173 patients, 50 (28.9%) experienced severe hemoptysis-related events. Risk-adjusted analysis revealed that age [hazard ratio (HR), 0.964; 95% confidence interval (CI), 0.939-0.989], blood-tinged sputum [HR, 2.717; 95% CI, 1.513-4.879], and thick wall cavitary fungus balls [HR, 2.332; 95% CI, 1.290-4.215] were significant predictors of severe hemoptysis-related events in patients with fungus ball. However, the baseline size of the fungus ball and its change rate were not independent risk factors for severe hemoptysis-related events. Besides, the decreased group did not have a favorable outcome in severe hemoptysis related to fungus ball.
Conclusions:
In a tertiary hospital, the incidence of severe hemoptysis-related events in patients with fungus ball was not low and reached 28.9%. Young patients, those with thick wall cavitary fungus ball, and those with complaints of blood-tinged sputum should be considered for early surgical treatment to prevent severe hemoptysis.
Insights
Severe hemoptysis complicates fungus balls in nearly 29% of patients. Young age, thick-walled cavitary fungus balls, and blood-tinged sputum are key risk factors, not initial size or size change.
Area of Science:
- Pulmonology
- Thoracic Surgery
Background:
- Fungus ball is a serious complication of lung diseases.
- Severe hemoptysis is a significant risk associated with fungus balls.
- The relationship between fungus ball size and hemoptysis risk is not fully understood.
Purpose of the Study:
- To identify clinical risk factors for severe hemoptysis in patients with fungus ball.
- To investigate the natural course of fungus ball progression and its impact on hemoptysis.
Main Methods:
- Retrospective study of 173 patients with fungus ball.
- Cox regression analysis to identify predictors of severe hemoptysis.
- Kaplan-Meier survival analysis to assess severe hemoptysis-free survival based on fungus ball size changes.
Main Results:
- Severe hemoptysis occurred in 28.9% of patients.
- Independent predictors of severe hemoptysis included younger age, blood-tinged sputum, and thick-walled cavitary fungus balls.
- Fungus ball size and rate of change were not independent risk factors; decreasing size did not correlate with better outcomes.
Conclusions:
- The incidence of severe hemoptysis in fungus ball patients is substantial (28.9%).
- Early surgical intervention may be warranted for younger patients, those with thick-walled cavitary fungus balls, and those experiencing hemoptysis.
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