Service de Pneumologie et Réanimation and Centre de Compétence sur les Maladies Rares Pulmonaires, Paris, France.
Eur Respir J. 2010 Jun;35(6):1303-11. doi: 10.1183/09031936.00075309. Epub 2009 Oct 19.
Diffuse alveolar haemorrhage (DAH) is a feature of several immune and nonimmune disorders. Reported prognosis is poor, with in-hospital mortality ranging from 20% to 100%. Early identification of prognostic factors may be useful in the initiation of appropriate treatment. We retrospectively analysed the charts of all patients referred to a university hospital for DAH between 1980 and 2008. Variables associated with in-hospital and long-term mortality were determined using a logistic regression model and the Kaplan-Meier method, respectively. Immunosuppressed patients were excluded. Overall, 97 patients were included in the study. In-hospital mortality was 24.7%. Factors associated with in-hospital mortality were shock (OR 77.5, 95% CI 8.9-677.2), glomerular filtration rate <60 mL x min(-1) (OR 11.2, 95% CI 1.8-68.4) and plasmatic lactate dehydrogenase level more than twice the normal value (OR 12.1, 95% CI 1.7-84.3). Mortality among discharged patients was 16.4% with a median follow-up duration of 34 months. Factors associated with increased long-term mortality in univariate analysis were age over 60 yrs (p = 0.026), cardiovascular comorbidity (p = 0.027) and end-stage renal failure with dependence on haemodialysis (p = 0.026). Patients with immune and nonimmune DAH had similar outcomes. Early outcome depended on nonpulmonary organ failures. Conversely, late outcome was related to age, cardiac comorbidities and the need for haemodialysis.
弥漫性肺泡出血（DAH）是几种免疫和非免疫性疾病的特征。据报道，其预后较差，住院病死率为 20%至 100%。早期识别预后因素可能有助于开始适当的治疗。我们回顾性分析了 1980 年至 2008 年期间因 DAH 被转诊至一所大学医院的所有患者的病历。使用逻辑回归模型和 Kaplan-Meier 方法分别确定与住院和长期死亡率相关的变量。排除了免疫抑制患者。共有 97 例患者纳入本研究。住院病死率为 24.7%。与住院病死率相关的因素包括休克（OR 77.5，95%CI 8.9-677.2）、肾小球滤过率<60mL x min(-1)（OR 11.2，95%CI 1.8-68.4）和血浆乳酸脱氢酶水平高于正常值两倍（OR 12.1，95%CI 1.7-84.3）。出院患者的死亡率为 16.4%，中位随访时间为 34 个月。单因素分析中与长期死亡率增加相关的因素包括年龄>60 岁（p = 0.026）、心血管合并症（p = 0.027）和终末期肾衰竭依赖血液透析（p = 0.026）。免疫性和非免疫性 DAH 患者的结局相似。早期结局取决于非肺部器官衰竭。相反，晚期结局与年龄、心脏合并症和血液透析的需求有关。
