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Published in: BMC Pulmonary Medicine 1/2021

Open Access 01-12-2021 | Bronchiectasis | Research

Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study

Authors: Rachel K. Lim, Alain Tremblay, Shengjie Lu, Ranjani Somayaji

Published in: BMC Pulmonary Medicine | Issue 1/2021

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Abstract

Background

The burden of hospitalizations and mortality for hemoptysis due to bronchiectasis is not well characterized. The primary outcome of our study was to evaluate in-hospital mortality in patients admitted with hemoptysis and bronchiectasis, as well as the rates of bronchial artery embolization, length of stay, and hospitalization costs.

Methods

The authors queried the Nationwide Inpatient Sample (NIS) claims database for hospitalizations between 2016 and 2017 using the ICD-10-CM codes for hemoptysis and bronchiectasis in the United States. Multivariable regression was used to evaluate predictors of in-hospital mortality, embolization, length of stay, and hospital costs.

Results

There were 8240 hospitalizations (weighted) for hemoptysis in the United States from 2016 to 2017. The overall in-hospital mortality was 4.5%, but higher in males compared to females. Predictors of in-hospital mortality included undergoing three or more procedures, age, and congestive heart failure. Bronchial artery embolization (BAE) was utilized during 2.1% of hospitalizations and was more frequently used in those with nontuberculous mycobacteria and aspergillus infections, but not pseudomonal infections. The mean length of stay was 6 days and the median hospitalization cost per patient was USD $9,610. Having comorbidities and procedures was significantly associated with increased length of stay and costs.

Conclusion

Hemoptysis is a frequent indication for hospitalization among the bronchiectasis population. In-hospital death occurred in approximately 4.5% of hospitalizations. The effectiveness of BAE in treating and preventing recurrent hemoptysis from bronchiectasis needs to be explored.
Literature
1.
go back to reference Seitz AE, Olivier KN, Steiner CA, MontesdeOca R, Holland SM, Prevots DR. Trends and burden of bronchiectasis− associated hospitalizations in the United States, 1993–2006. Chest. 2010;138(4):944–9.CrossRef Seitz AE, Olivier KN, Steiner CA, MontesdeOca R, Holland SM, Prevots DR. Trends and burden of bronchiectasis− associated hospitalizations in the United States, 1993–2006. Chest. 2010;138(4):944–9.CrossRef
2.
go back to reference Weycker D, Edelsberg J, Oster G, Tine G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005;12(4):205–9.CrossRef Weycker D, Edelsberg J, Oster G, Tine G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005;12(4):205–9.CrossRef
3.
go back to reference Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis. 2017;14(4):377–84.CrossRef Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis. 2017;14(4):377–84.CrossRef
4.
go back to reference Chalmers JD, Aliberti S, Filonenko A, Shteinberg M, Goeminne PC, Hill AT, et al. Characterization of the “frequent exacerbator phenotype” in bronchiectasis. AJRCCM. 2018;197(11):1410–20. Chalmers JD, Aliberti S, Filonenko A, Shteinberg M, Goeminne PC, Hill AT, et al. Characterization of the “frequent exacerbator phenotype” in bronchiectasis. AJRCCM. 2018;197(11):1410–20.
5.
go back to reference Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fi brosis bronchiectasis (EMBRACE): A randomised, double-blind, placebo-controlled trial. Lancet. 2012;380:660–7.CrossRef Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fi brosis bronchiectasis (EMBRACE): A randomised, double-blind, placebo-controlled trial. Lancet. 2012;380:660–7.CrossRef
6.
go back to reference Serisier DJ, Bilton D, De Soyza A, et al. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax. 2013;68:812–7.CrossRef Serisier DJ, Bilton D, De Soyza A, et al. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax. 2013;68:812–7.CrossRef
7.
go back to reference Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA. 2013;309:1260–7.CrossRef Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA. 2013;309:1260–7.CrossRef
8.
go back to reference Altenburg J. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non–cystic fibrosis bronchiectasis. JAMA. 2013;309:1251–9.CrossRef Altenburg J. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non–cystic fibrosis bronchiectasis. JAMA. 2013;309:1251–9.CrossRef
11.
go back to reference Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020;71(4):905–13.CrossRef Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020;71(4):905–13.CrossRef
12.
go back to reference Osaki S, Nakanishi Y, Wataya H, et al. Prognosis of bronchial artery embolization in the management of hemoptysis. Respiration. 2000;67:412.CrossRef Osaki S, Nakanishi Y, Wataya H, et al. Prognosis of bronchial artery embolization in the management of hemoptysis. Respiration. 2000;67:412.CrossRef
13.
go back to reference King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006;100:2183–9.CrossRef King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006;100:2183–9.CrossRef
14.
go back to reference McShane PJ, Naureckas ET, Tino G, Strek ME. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2013;188:647–56.CrossRef McShane PJ, Naureckas ET, Tino G, Strek ME. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2013;188:647–56.CrossRef
15.
go back to reference Fruchter O, Schneer S, Rusanov V, Belenky A, Kramer MR. Bronchial artery embolization for massive hemoptysis: long term follow-up. Asian Cardiovasc Thorac Ann. 2015;23(1):55–60.CrossRef Fruchter O, Schneer S, Rusanov V, Belenky A, Kramer MR. Bronchial artery embolization for massive hemoptysis: long term follow-up. Asian Cardiovasc Thorac Ann. 2015;23(1):55–60.CrossRef
16.
go back to reference Choi J, Baik JH, Kim CH, Song SH, Kim SK, Kim M, et al. Long-term outcomes and prognostic factors in patients with mild hemoptysis. Am J Emerg Med. 2018;36:1160–5.CrossRef Choi J, Baik JH, Kim CH, Song SH, Kim SK, Kim M, et al. Long-term outcomes and prognostic factors in patients with mild hemoptysis. Am J Emerg Med. 2018;36:1160–5.CrossRef
17.
go back to reference Buscot M, Pottier H, Marquette CH, Leroy S. Phenotyping adults with non-cystic fibrosis bronchiectasis: a 10-year cohort study in a French regional university hospital center. Respiration. 2016;92:1–8.CrossRef Buscot M, Pottier H, Marquette CH, Leroy S. Phenotyping adults with non-cystic fibrosis bronchiectasis: a 10-year cohort study in a French regional university hospital center. Respiration. 2016;92:1–8.CrossRef
18.
go back to reference Aksamit TR, O’Donnell AE, Barker A, Olivier KN, Winthrop KL, Daniels MLA, et al. Adults patients with bronchiectasis. A first look at the US bronchiectasis research registry. Chest. 2017;151(5):982–92.CrossRef Aksamit TR, O’Donnell AE, Barker A, Olivier KN, Winthrop KL, Daniels MLA, et al. Adults patients with bronchiectasis. A first look at the US bronchiectasis research registry. Chest. 2017;151(5):982–92.CrossRef
19.
go back to reference Antonelli M, Midulla F, Tancredi G, et al. Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis. Chest. 2002;121:796–801.CrossRef Antonelli M, Midulla F, Tancredi G, et al. Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis. Chest. 2002;121:796–801.CrossRef
20.
go back to reference Miyano Y, Kanzaki M, Onuki T. Bronchial artery embolization: first-line option for managing massive hemoptysis. Asian Cardio Thoracic Ann. 2017;25(9):618–22.CrossRef Miyano Y, Kanzaki M, Onuki T. Bronchial artery embolization: first-line option for managing massive hemoptysis. Asian Cardio Thoracic Ann. 2017;25(9):618–22.CrossRef
21.
go back to reference Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017;23:307–17.CrossRef Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017;23:307–17.CrossRef
22.
go back to reference Goeminne PC, Hernandez F, Diel R, Filonenko A, Hughes R, Juelich F, et al. The economic burden of bronchiectasis – known and unknown: a systematic review. BMC Pulm Med. 2019;19:54.CrossRef Goeminne PC, Hernandez F, Diel R, Filonenko A, Hughes R, Juelich F, et al. The economic burden of bronchiectasis – known and unknown: a systematic review. BMC Pulm Med. 2019;19:54.CrossRef
23.
go back to reference Blanchette C, Noone J, Stone G, Zacherle E, Patel RP, Runken MC, Howden R, Mapel D. Healthcare cost and utilization before and after diagnosis of pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US. Med Sci. 2017;5(20):1–8. Blanchette C, Noone J, Stone G, Zacherle E, Patel RP, Runken MC, Howden R, Mapel D. Healthcare cost and utilization before and after diagnosis of pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US. Med Sci. 2017;5(20):1–8.
24.
go back to reference Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, et al. Adherence to methodological standards in research using the national inpatient sample. JAMA. 2017;318(20):2011–8.CrossRef Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, et al. Adherence to methodological standards in research using the national inpatient sample. JAMA. 2017;318(20):2011–8.CrossRef
25.
go back to reference Finklea JD, Khan G, Thomas S, Song J, Myers D, Arroliga AC. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med. 2010;104(6):816–21.CrossRef Finklea JD, Khan G, Thomas S, Song J, Myers D, Arroliga AC. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med. 2010;104(6):816–21.CrossRef
26.
go back to reference Alzeer AH, Masood M, Jani BS, et al. Survival of brochiectatic patients with respiratory failure in ICU. BMC Pulm Med. 2007;7:17.CrossRef Alzeer AH, Masood M, Jani BS, et al. Survival of brochiectatic patients with respiratory failure in ICU. BMC Pulm Med. 2007;7:17.CrossRef
27.
go back to reference Dupont M, Gacouin A, Lena H, et al. Survival of patients with bronchiectasis after the first ICU stay for respiratory failure. Chest. 2004;125:1815–20.CrossRef Dupont M, Gacouin A, Lena H, et al. Survival of patients with bronchiectasis after the first ICU stay for respiratory failure. Chest. 2004;125:1815–20.CrossRef
29.
go back to reference Lee MK, Kim S, Yong SJ, Shun KC, Kim HS, Yu T, et al. Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization. Clin Respir J. 2015;9:54–64. Lee MK, Kim S, Yong SJ, Shun KC, Kim HS, Yu T, et al. Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization. Clin Respir J. 2015;9:54–64.
30.
go back to reference Hannah CE, Ford BA, Chung J, Ince D, Wanat KA. Characteristics of nontuberculous mycobacterial infections at a Midwestern tertiary hospital: a retrospective study of 365 patients. Open Forum Infect Dis. 2020;7(6):ofaa173.CrossRef Hannah CE, Ford BA, Chung J, Ince D, Wanat KA. Characteristics of nontuberculous mycobacterial infections at a Midwestern tertiary hospital: a retrospective study of 365 patients. Open Forum Infect Dis. 2020;7(6):ofaa173.CrossRef
31.
go back to reference Lee SH, Lee JH, Chang JH, et al. Hemoptysis requiring bronchial artery embolization in patients with nontuberculous mycobacterial lung disease. BMC Pulm Med. 2019;19(1):117.CrossRef Lee SH, Lee JH, Chang JH, et al. Hemoptysis requiring bronchial artery embolization in patients with nontuberculous mycobacterial lung disease. BMC Pulm Med. 2019;19(1):117.CrossRef
33.
go back to reference van der Molen AJ, Reimer P, Dekkers IA, et al. Post-contrast acute kidney injury—Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2018;28(7):2845–55.CrossRef van der Molen AJ, Reimer P, Dekkers IA, et al. Post-contrast acute kidney injury—Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2018;28(7):2845–55.CrossRef
Metadata
Title
Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study
Authors
Rachel K. Lim
Alain Tremblay
Shengjie Lu
Ranjani Somayaji
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2021
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-021-01762-6

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