Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization

The studies on hemoptysis have focused mainly on hemoptysis causes and massive or life‐threatening hemoptysis. And there is a limited data that non‐massive hemoptysis, especially moderate hemoptysis. Objectives We analyzed the prognosis and severity of bleeding on flexible bronchoscopy ( FB ) between moderate and massive hemoptysis. Methods We reviewed total 852 subjects (59.9 ± 16.0 years) identified with hemoptysis. Reviewed database included severity of subjective hemoptysis, bleeding on FB , comorbid conditions, time from admission to bronchial artery embolization ( BAE ), recurrent hemoptysis and mortality. Results In subjective hemoptysis, recurrent hemoptysis occurred in mild 8.0%, moderate 40.7%, massive hemoptysis 33.8%, and mortality was 4.7%, 13.4% and 13.5%. Especially, no statistical difference was shown in recurrent hemoptysis [hazard ratio ( HR ) = 0.795; 95% confidence interval ( CI ) 0.562–1.125, P  = 0.196] and mortality ( HR  = 1.054; 95% CI 0.596–1.864, P  = 0.856) between moderate and massive hemoptysis. In moderate hemoptysis patients, oozing or active bleeding on FB took up 83.3%. In this review, recurrent hemoptysis was more in oozing bleeding than active bleeding ( HR  = 1.781; 95% CI 1.214–2.431, P  = 0.002), but mortality was similar ( HR  = 1.611; 95% CI 0.930–2.790, P  = 0.089). Recurrent hemoptysis significantly decreased in the group with BAE performed within 24 h ( HR  = 0.308; 95% CI 0.149–0.637, P  = 0.001) in moderate hemoptysis. Also, recurrent hemoptysis and mortality were significantly increased in the patients with smoking (≥40 pack‐years), oozing or active bleeding on FB , and hypertension. Conclusion Moderate hemoptysis has shown similar prognosis of recurrent hemoptysis and mortality to massive hemoptysis. Therefore, the more aggressive FB and BAE should be considered in moderate hemoptysis.