Severe hemoptysis associated with lung cancer in the ICU: recurrence and outcome

Hemoptysis is a life-threatening event in the course of lung cancer (LC). The management of the most severe episodes of hemoptysis include medical measures and vascular interventional radiology (VIR). There are few data on initial clinical and radiological features associated with early bleeding recurrence, and its prognostic significance.

A monocenter retrospective study involving patients admitted to the intensive care unit (ICU) between 2009 and 2020 for severe hemoptysis (SH) associated with LC and requiring VIR.

During the study period, 130 patients (85% males; 59.5 ± 5.3 yrs) with SH and non-small cell (78%) or small-cell (18%) LC were analysed. SH was inaugural in half of cases. A lower respiratory tract infection (LRTI) was microbiologically documented in 39% of cases. All patients received a first-line VIR, including systemic bronchial and non-bronchial arteriography with embolisation (n = 117) and/or pulmonary arterial vaso-occlusion (n = 20). Bleeding recurred in 34% cases, after 1 day [1-3] of initial VIR attempt. Overall, the 28-day, 6-month and 12-month mortality rates were 25.3%, 47.7% and 63%, respectively. Intravenous terlipressin prior to VIR (OR 4.43, p = 0.001) and LRTI (OR 2.93; p = 0.007) were independently associated with bleeding recurrence. Tumoral cavitation (HR 3.37; p = 0.004), Staphylococcus aureus infection (HR 8.3; p = 0.005) and bleeding recurrence (HR 2.68; p = 0.01) were independently associated with one-year mortality.

Lung cancer-related SH is associated with a high rate of bleeding recurrence and a poor prognosis. The association of Staphylococcus aureus infection with recurrence and mortality raises the potential interest of the administration of antibacterial treatment in that context.