Salvayre Raphael, Hanotin Clément, Parrot Antoine, Dessajan Julien, Elabbadi Alexandre, Pasquier-Meunier Nicolas, Fartoukh Muriel, Barral Matthias, Gibelin Aude
Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
Assistance Publique-Hôpitaux de Paris, Service de Radiologie, Hôpital Tenon, Sorbonne Université, Paris, France.
Ann Intensive Care. 2025 Mar 20;15(1):33. doi: 10.1186/s13613-025-01421-7.
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.
咯血是肺癌（LC）病程中的一种危及生命的事件。最严重咯血发作的治疗包括药物治疗和血管介入放射学（VIR）。关于与早期出血复发相关的初始临床和放射学特征及其预后意义的数据很少。
一项单中心回顾性研究，纳入了2009年至2020年间因与LC相关的严重咯血（SH）而入住重症监护病房（ICU）并需要VIR的患者。
在研究期间，分析了130例SH患者（85%为男性；59.5±5.3岁），其中非小细胞肺癌（78%）或小细胞肺癌（18%）。半数病例中SH为首发症状。39%的病例有微生物学记录的下呼吸道感染（LRTI）。所有患者均接受了一线VIR，包括系统性支气管和非支气管动脉造影及栓塞（n = 117）和/或肺动脉血管闭塞（n = 20）。34%的病例在初次VIR尝试后1天[1 - 3]出现出血复发。总体而言，28天、6个月和12个月的死亡率分别为25.3%、47.7%和63%。VIR前静脉注射特利加压素（OR 4.43，p = 0.001）和LRTI（OR 2.93；p = 0.007）与出血复发独立相关。肿瘤空洞形成（HR 3.37；p = 0.004）、金黄色葡萄球菌感染（HR 8.3；p = 0.005）和出血复发（HR 2.68；p = 0.01）与一年死亡率独立相关。
肺癌相关的SH与高出血复发率和不良预后相关。金黄色葡萄球菌感染与复发和死亡率的关联增加了在这种情况下进行抗菌治疗的潜在意义。
