Clinical features of patients with hemoptysis requiring invasive mechanical ventilation

Hemoptysis severity is commonly classified by daily hemorrhagic volume; however, a uniform definition remains lacking. We examined clinical factors, including hemorrhagic volume at admission, associated with severe progression (defined as the need for invasive mechanical ventilation [IMV]) to identify patients with hemoptysis requiring prompt therapeutic intervention.

In this retrospective cohort study, we analyzed 122 patients (57 men, 65 women) urgently admitted to Shonan Kamakura General Hospital between April 2014 and June 2024. Logistic regression analysis was used to identify the background factors associated with severe progression.

The median age was 77 years (range, 22-96). The major causes of hemoptysis included bronchiectasis (n = 42, 34%), cryptogenic hemoptysis (n = 27, 22%), malignant tumors (n = 15, 12%), and non-tuberculous mycobacterial disease (n = 14, 11%). Twenty-two patients (18%) required IMV. In the multivariate analysis, significant predictors of severe progression were male sex (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.05-11.38), cryptogenic hemoptysis (OR, 3.23; 95% CI, 1.01-10.68), and oxygen administration upon hospital arrival (OR, 9.40; 95% CI, 2.60-42.06). Furthermore, the presence of bronchial secretions on admission computed tomography (CT; OR, 4.05; 95% CI, 0.89-29.56) was associated with a tendency to require IMV.

Male patients with cryptogenic hemoptysis, bronchial secretions on CT, or who require oxygen upon arrival at the hospital are at high risk of severe progression and should be considered for early therapeutic intervention.