Journal Article

Triage risk stratification in emergency department hemoptysis: associations of hemoglobin and malignancy with in-hospital mortality

Derya, Serdar, Pepele, Mustafa Safa, Murat, Mahmut

2025

Overview

A clinically important subset of emergency department (ED) patients with hemoptysis deteriorates rapidly due to airway obstruction, hypoxemia, or hemodynamic compromise. Practical, ED-available variables are needed to prompt CT angiography (CTA) and appropriate interventional radiology (IR) notifications. To identify independent predictors of in-hospital mortality in patients with hemoptysis and to describe early bronchial artery embolization (BAE) as a process-of-care marker. This retrospective cohort study was conducted at a tertiary teaching ED in Türkiye (June 2020–June 2025). Adults with hemoptysis were included, while those with pseudohemoptysis/hematemesis, trauma, pregnancy, incomplete outcome data, and repeat encounters were excluded. The variables captured included demographics, comorbidities (malignancy/bronchiectasis/tuberculosis/COPD), British Thoracic Society (BTS) hemoptysis severity, first 6-h hemoglobin (g/dL), imaging, and interventions (bronchoscopy; BAE recorded descriptively as planned/performed within 24 h). The primary outcome was in-hospital mortality rate. We fitted a Firth-penalized logistic regression and assessed discrimination and calibration using bootstrap internal validation. Among 391 encounters (mean age 56.7; 76.7 % male), the mortality rate was 4.1 %. Non-survivors had lower hemoglobin levels and more malignancies, and BAE clustered in sicker patients. In the multivariable analysis (with BAE excluded as a predictor), mortality was associated with malignancy (adjusted odds ratio [aOR] 4.07; 95 % confidence interval [CI] 1.20–13.74) and hemoglobin (per 1 g/dL) (aOR 0.76; 95 % CI 0.62–0.94). Model discrimination was strong (AUC 0.884) with acceptable calibration (intercept, −0.03; slope, 1.07). The sensitivity analyses were consistent. Two triage-available variables, malignancy and lower hemoglobin levels, identified a higher-risk subgroup of ED patients with hemoptysis in our cohort. These findings support early risk stratification at presentation and warrant prospective multicenter validation.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Aged / Angiography / British Thoracic Society / Bronchial Arteries / Bronchial artery embolization / Bronchiectasis / Bronchoscopy / Calibration / Cancer / Chronic obstructive pulmonary disease / Comorbidity / Computed Tomography Angiography / Creatinine / CT angiography / Embolization / Embolization, Therapeutic / Emergency / Emergency department / Emergency medical care / Emergency Service, Hospital - statistics & numerical data / Estimates / Female / Gender / Hemodynamics / Hemoglobin / Hemoglobins - analysis / Hemoptysis / Hemoptysis - blood / Hemoptysis - etiology / Hemoptysis - mortality / Hemoptysis - therapy / Hospital Mortality / Hospitals / Humans / Hypoxemia / Interventional radiology / Laboratories / Length of stay / Male / Malignancy / Medical imaging / Middle Aged / Mortality / Neoplasms - complications / Radiology / Regression analysis / Retrospective Studies / Risk / Risk Assessment - methods / Risk groups / Risk stratification / Sensitivity analysis / Thoracic surgery / Thorax / Triage - methods / Tuberculosis / Variables / Veins & arteries