scholarly journals Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hai-Tao Yan ◽  
Guang-Dong Lu ◽  
Xiang-Zhong Huang ◽  
Da-Zhong Zhang ◽  
Kun-Yuan Ge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Bronchial Artery ◽  
Model Performance ◽  
Arterial Embolization ◽  
Brier Score ◽  
Study Cohort ◽  
Imaging Features ◽  
Bronchial Arterial Embolization ◽  
Predictor Model

Abstract Background Relapse after effective bronchial arterial embolization (BAE) for controlling hemoptysis is not uncommon. Studies reported diverse predictors of recurrence. However, a model to assess the probability of recurrence in non-cancer related hemoptysis patients after BAE has not been reported. This study was to develop a model to predict recurrence after BAE for non-cancer related hemoptysis. Methods The study cohort included 487 patients who underwent BAE for non-cancer-related hemoptysis between January 2015 and December 2019. We derived the model’s variables from univariate and multivariate Cox regression analyses. The model presented as a nomogram scaled by the proportional regression coefficient of each predictor. Model performance was assessed with respect to discrimination and calibration. Results One-month and 1-, 2-, 3- and 5-year recurrence-free rates were 94.5%, 88.0%, 81.4%, 76.2% and 73.8%, respectively. Risk factors for recurrence were underlying lung diseases and the presence of systemic arterial-pulmonary circulation shunts. This risk prediction model with two risk factors provided good discrimination (area under curve, 0.69; 95% confidence interval, 0.62–0.76), and lower prediction error (integrated Brier score, 0.143). Conclusion The proposed model based on routinely available clinical and imaging features demonstrates good performance for predicting recurrence of non-cancer-related hemoptysis after BAE. The model may assist clinicians in identifying higher-risk patients to improve the long-term efficacy of BAE.

scholarly journals 656Risk factors for lung cancer in never-smokers in Australia

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Elvin Cheng ◽  
Marianne Weber ◽  
Julia Steinberg ◽  
Karen Canfell ◽  
Xue Qin Yu
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Potential Risk ◽  
Cox Regression ◽  
Distinct Type ◽  
Case Control ◽  
Study Cohort ◽  
Health Related ◽  
Potential Risk Factors ◽  
Never Smokers

Abstract Background Lung cancer in never-smokers (LCINS), if considered as a distinct type, would rank as Australia’s eighth most deadly cancer. We investigated several demographic, lifestyle and health-related risk factors for LCINS in Australia. Methods Using the longitudinal 45 and Up Study cohort with 267,153 New South Wales (NSW) residents aged ≥45 years at recruitment (2006-2009), we quantified the relationship of 20 potential risk factors with LCINS. Self-reported never-smoking participants who were cancer-free at baseline were followed for incident lung cancer (LC), and adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. The NSW Cancer, Lifestyle and Evaluation of Risk (CLEAR) Study, a case-control study including 10,781 NSW residents aged ≥18 years, was also used to examine 16 potential risk factors for LCINS. Adjusted odds ratios (OR) and 95% CI for LC were estimated using logistic regression. Results In the 45 and Up Study, there were 226 LC cases among 132,354 cancer-free never-smokers with a median follow-up of 5.41 years. In the CLEAR Study, there were 58 LCINS cases and 1316 cancer-free never-smoking controls. After adjusting for potential confounders, analyses of both datasets showed that Asian-born participants had a higher risk of LCINS than those born elsewhere: cohort HR = 2.83 (95% CI: 1.64-4.89) and case-control OR = 3.78 (95% CI: 1.19-12.05). Conclusions Our findings support the growing evidence that never-smokers born in Asia are at higher risk of developing LC than those born elsewhere. Key messages Region of birth could be considered when assessing potential LC risk among never-smokers.

Effect of bronchial artery embolisation on the management of tuberculosis-related haemoptysis

2019 ◽  
Vol 23 (12) ◽  
pp. 1269-1276
Author(s):  
Y. Peng ◽  
Y. Zhu ◽  
G. Ao ◽  
Z. Chen ◽  
X. Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cox Regression ◽  
Bronchial Artery ◽  
Cox Regression Analysis ◽  
Pleural Thickening ◽  
Factors Influencing ◽  
Arterial Embolisation ◽  
Independent Risk Factors ◽  
Bronchial Artery Embolisation

OBJECTIVE: To identify risk factors influencing outcomes of bronchial arterial embolisation (BAE) in tuberculosis (TB) related haemoptysis.METHODS: A cohort of 207 patients underwent BAE for TB-related haemoptysis between March 2014 and March 2018. The clinical data were reviewed. Follow-up ranged from 24 to 1749 days.RESULTS: Immediate haemostasis rate was 94.2%; aggressive pleural thickening (PT) was found to be a risk factor for haemoptysis (P = 0.000, OR 22.52). Cumulative recurrence-free rates were respectively 98.5%, 94.8%, 88.7%, 79.9%, 68.5%, 65.7% and 62.7% for 1, 3, 6, 12, 24, 36 and 48 months. Respectively 8 and 15 patients recovered from pneumonectomy and re-BAE. However, five patients required a third BAE. The Cox regression analysis indicated that aggressive PT (P = 0.000), diabetes mellitus (DM) (P = 0.018) and pulmonary fungal infection (PFI) (P = 0.001) were independent risk factors for recurrence. The death rate following BAE was 9.2%; aggressive PT was a risk factor (P = 0.000, OR 8.14).CONCLUSION: BAE is effective for TB-related haemoptysis in most cases. Aggressive PT, DM and PFI are independent risk factors influencing the prognosis following BAE. PFI and DM should be well managed, while proper surgery should be considered for aggressive PT.

Therapeutic approach in haemoptysis

2016 ◽  
Author(s):  
Francesco Blasi ◽  
Paolo Tarsia
Keyword(s):  
Bronchial Artery ◽  
Balloon Catheter ◽  
Arterial Embolization ◽  
Lung Parenchyma ◽  
Pulmonary Vasculature ◽  
Respiratory Compromise ◽  
Contrast Enhanced Ct ◽  
Massive Haemoptysis ◽  
Bronchial Arterial Embolization ◽  
Chest X Ray

The aim of diagnostic studies in patients with haemoptysis is two-fold—locate the source of bleeding and identify the underlying cause. A chest X-ray may be informative regarding conditions involving the lung parenchyma, pulmonary vasculature, or the heart, but may be normal in 20–40% of cases. A chest CT scan may allow correct localization of the bleeding site in 65–100% of cases. Contrast-enhanced CT scans allow high resolution angiographic studies that may be useful prior to planning bronchial arterial embolization. Bronchoscopy may allow identification of the site of bleeding, identify the underlying cause, help clear the airways from blood clots favouring gas exchange, and be a means to stop the bleeding. Treatment of haemoptysis varies from outpatient management to intensive care unit admittance. Choice of optimal management depends on the intensity of bleeding, degree of respiratory compromise, and severity of underlying cardiorespiratory status. Important steps in the management of patients with massive haemoptysis include resuscitation, airway protection and patient stabilization as the priority, subsequent localization of the site of bleeding, and specific interventions to stop the bleeding and prevent recurrence. Bronchoscopy may be useful in stopping bleeding through use of cold saline lavage, use of topical vasoconstrictive agents, or temporary endobronchial tamponade with a balloon catheter. The procedure of choice in many cases is selective bronchial artery embolization. With this procedure immediate control of bleeding may be obtained in 70–95% of patients, although recurrence has been reported in 10–30% of cases.

scholarly journals A rare and fatal respiratory disease: bronchial Dieulafoy’s disease

2020 ◽  
Vol 14 ◽  
pp. 175346662092923
Author(s):  
Shi-xia Liao ◽  
Peng-peng Sun ◽  
Bang-guo Li ◽  
Shuang-fei He ◽  
Mao-mao Liu ◽  
...  
Keyword(s):  
Bronchial Artery ◽  
Arterial Embolization ◽  
Normal Mucosa ◽  
Middle Lobe ◽  
Massive Hemoptysis ◽  
Lobe Bronchus ◽  
Bronchial Lumen ◽  
Bronchial Arterial Embolization ◽  
Dieulafoy’S Disease ◽  
The Right

A 66-year-old woman had two severe episodes of massive hemoptysis without any premonitory symptoms, with approximately 400–500 ml blood each time. Bronchoscopic exam revealed a smooth and pulsatile protrusion that was approximately 8–10 mm in diameter found at the beginning of the right middle lobe bronchus in the bronchial lumen. The protrusion arose from the surface with absolutely normal mucosa. Selective bronchial arteriography showed that elongated, tortuous, and dilated branches of the bronchial artery in the region of the middle lobe bronchus. Further bronchial arterial embolization (BAE) is recommended, although the patient currently has no active bleeding. Bronchial Dieulafoy’s disease (BDD) is a rare and life-threatening disease. Selective bronchial arteriography is a diagnostic tool to detect and locate abnormal arteries. There is no unified guideline or expert consensus on the treatment of BDD. Selective BAE or surgical resection is usually used as a first-line treatment to control hemoptysis. The reviews of this paper are available via the supplemental material section.

scholarly journals Bronchial artery embolization being the therapy of choice for massive hemoptyses in bronchiectases

2009 ◽  
Vol 66 (9) ◽  
pp. 749-753
Author(s):  
Mirna Djuric ◽  
Djordje Povazan ◽  
Slobodan Puskar ◽  
Nada Cemerlic-Adjic ◽  
Dusan Skrbic
Keyword(s):  
Bronchial Artery ◽  
Radiological Finding ◽  
Left Lung ◽  
Arterial Embolization ◽  
Left Lobe ◽  
Bronchial Arteries ◽  
Lower Left Lobe ◽  
Bronchial Arterial Embolization ◽  
Tomography Finding ◽  
Life Threatening

Introduction. Hemoptyses may be very often due to bronchiectases. Although these bleedings are usually spontaneously resolved recurrent and massive hemoptyses may vitally endanger a patient. Therefore, an urgent diagnosis and treatment of hemoptyses is required. Case report. A 56- year old patient was admitted to the hospital due to massive hemoptyses, presented with a non-homogenous shadowing, paracardially on the left. The chest Computerized Tomography finding delineated atelectasis of the lower left lobe and bronchiectases. Bronchoscopy sampling of the left lung airways provided the fresh blood. The multislice angiography and embolization of the bronchial arteries was carried out, entirely ceasing hemoptyses so the patient was discharged with no symptoms. On the control examination one month later, he was well, with normal radiological finding and inflammation markers. Conclusion. In our patient, the life-threatening bleeding due to inflamed bronchiectases was successfully resolved by bronchial arterial embolization, thus avoiding surgery.

scholarly journals Risk Factors and Outcomes of Endocarditis Due to Non-HACEK Gram-Negative Bacilli: Data from the Prospective Multicenter Italian Endocarditis Study Cohort

2018 ◽  
Vol 62 (4) ◽  
Author(s):  
Marco Falcone ◽  
Giusy Tiseo ◽  
Emanuele Durante-Mangoni ◽  
Veronica Ravasio ◽  
Francesco Barbaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Electronic Device ◽  
Multidrug Resistant ◽  
Study Cohort ◽  
Gram Negative ◽  
Content Type ◽  
Cox Regression Analysis ◽  
Factors Associated

ABSTRACT The objective of this study was to investigate predisposing factors and outcomes of infective endocarditis (IE) caused by non-HACEK Gram-negative bacilli (GNB) in a contemporary multicenter cohort. Patients with IE due to GNB, prospectively observed in 26 Italian centers from 2004 to 2011, were analyzed. Using a case-control design, each case was compared to three age- and sex-matched controls with IE due to other etiologies. Logistic regression was performed to identify risk factors for IE due to GNB. Factors associated with early and late mortality were assessed by Cox regression analysis. The study group comprised 58 patients with IE due to GNB. We found that Escherichia coli was the most common pathogen, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae . The genitourinary tract as a source of infection (odds ratio [OR], 13.59; 95% confidence interval [CI], 4.63 to 39.93; P < 0.001), immunosuppression (OR, 5.16; 95% CI, 1.60 to 16.24; P = 0.006), and the presence of a cardiac implantable electronic device (CIED) (OR, 3.57; 95% CI, 1.55 to 8.20; P = 0.003) were factors independently associated with IE due to GNB. In-hospital mortality was 13.8%, and mortality rose to 30.6% at 1 year. A multidrug-resistant (MDR) etiology was associated with in-hospital mortality (hazard ratio [HR], 21.849; 95% CI, 2.672 to 178.683; P = 0.004) and 1-year mortality (HR, 4.408; 95% CI, 1.581 to 12.287; P = 0.005). We conclude that the presence of a genitourinary focus, immunosuppressive therapy, and an indwelling CIED are factors associated with IE due to GNB. MDR etiology is the major determinant of in-hospital and long-term mortality.

scholarly journals Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiang Tong ◽  
Tao Liu ◽  
Kexin Jiang ◽  
Dongguang Wang ◽  
Sitong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Pleural Effusion ◽  
Cox Regression ◽  
Invasive Pulmonary Aspergillosis ◽  
Imaging Features ◽  
Pulmonary Aspergillosis ◽  
Cox Regression Analysis ◽  
Survivor Group

Background: The mortality and burden of medical costs associated with invasive pulmonary aspergillosis (IPA) is very high. Currently, the clinical features and prognostic factors of patients with proven IPA are not very clear, especially in the Chinese population. In this retrospective analysis, we aimed to identify the clinical features and prognostic factors of patients with proven IPA.Methods: The diagnostic criteria for proven IPA were based on the international consensus of the EORTC/MSG. Data of patients with proven IPA at the West China Hospital of Sichuan University between January 2012 and December 2018 were collected. The optimal cut-off value of continuous variables was determined by Receiver Operating Characteristic curve and maximum Youden's index. Finally, using the Cox regression analysis to identify correlations between the clinical parameters associated with morbidity.Results: A total of 117 patients with proven IPA were included in the study, and 32 (27.4%) patients died during the follow-up period. Compared with the survivor group, elderly, patients with comorbidities, and patients undergoing chemotherapy and the level of inflammatory biomarkers [erythrocyte sedimentation rate, platelet count, interleukin-6, C-reactive protein (CRP)] in the non-survivor group were higher, while the albumin level was lower (P = 0.018). The imaging features were consolidation, nodules, cavities, pleural effusion, ground-glass shadows, and halo signs in order. Overall, 41.0% patients had mixed imaging features. The results suggested the most appropriate cut-off value of age and CRP were 60 years and 14.1 mg/L, respectively. The multivariate Cox regression analysis suggested that advanced age (&gt;60 years) [hazard ratio (HR): 10.7, confidence interval (CI): 2.5–44.9, P &lt; 0.001), undergoing chemotherapy (HR: 9.5, CI: 2.7–32.9, P &lt; 0.001), presence of pleural effusion (HR: 5.74, CI: 1.6–20.8, P = 0.008), and increased CRP levels (&gt;14.1 mg/L) (HR: 6.3, CI: 1.2–34.3, P = 0.033) were risk factors for all-cause mortality in patients with proven aspergillosis.Conclusions: This study showed that the prognosis of proven IPA is poor, and the age &gt;60 years, undergoing chemotherapy, pleural effusion on CT image, and CRP levels &gt;14.1 mg/L may be as risk factors for mortality in patients with proven IPA. large samples and real-world studies are needed to confirm these results in the future.

Bronchial Arterial Embolization for Hemoptysis: Analysis of Outcome in Various Underlying Causes

1999 ◽  
Vol 41 (1) ◽  
pp. 45 ◽  
Author(s):  
Jeong Min Lee ◽  
Hyo Sung Kwak ◽  
Young Min Han ◽  
Yang Keun Lee ◽  
Hyeun Young Han ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Bronchial Arterial Embolization ◽  
Underlying Causes
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