Triage risk stratification in emergency department hemoptysis: associations of hemoglobin and malignancy with in-hospital mortality
Küçük Resim Yok
Tarih
2025
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
W B Saunders Co-Elsevier Inc
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Background: A clinically important subset of emergency department (ED) patients with hemoptysis deteriorates rapidly due to airway obstruction, hypoxemia, or hemodynamic compromise. Practical, ED-available variables are needed to prompt CT angiography (CTA) and appropriate interventional radiology (IR) notifications. Objectives: To identify independent predictors of in-hospital mortality in patients with hemoptysis and to describe early bronchial artery embolization (BAE) as a process-of-care marker. Methods: This retrospective cohort study was conducted at a tertiary teaching ED in T & uuml;rkiye (June 2020-June 2025). Adults with hemoptysis were included, while those with pseudohemoptysis/hematemesis, trauma, pregnancy, incomplete outcome data, and repeat encounters were excluded. The variables captured included demographics, comorbidities (malignancy/bronchiectasis/tuberculosis/COPD), British Thoracic Society (BTS) hemoptysis severity, first 6-h hemoglobin (g/dL), imaging, and interventions (bronchoscopy; BAE recorded descriptively as planned/performed within 24 h). The primary outcome was in-hospital mortality rate. We fitted a Firth-penalized logistic regression and assessed discrimination and calibration using bootstrap internal validation. Results: Among 391 encounters (mean age 56.7; 76.7 % male), the mortality rate was 4.1 %. Non-survivors had lower hemoglobin levels and more malignancies, and BAE clustered in sicker patients. In the multivariable analysis (with BAE excluded as a predictor), mortality was associated with malignancy (adjusted odds ratio [aOR] 4.07; 95 % confidence interval [CI] 1.20-13.74) and hemoglobin (per 1 g/dL) (aOR 0.76; 95 % CI 0.62-0.94). Model discrimination was strong (AUC 0.884) with acceptable calibration (intercept, -0.03; slope, 1.07). The sensitivity analyses were consistent. Conclusions: Two triage-available variables, malignancy and lower hemoglobin levels, identified a higher-risk subgroup of ED patients with hemoptysis in our cohort. These findings support early risk stratification at presentation and warrant prospective multicenter validation. (c) 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Açıklama
Anahtar Kelimeler
Hemoptysis, Emergency department, Mortality, Malignancy, Hemoglobin, British Thoracic Society, CT angiography, Interventional radiology, Risk stratification, Bronchial artery embolization
Kaynak
American Journal of Emergency Medicine
WoS Q Değeri
Q2
Scopus Q Değeri
Q1
Cilt
98
