C77-41 Predictors of Recurrent Hemoptysis in Patients With Cancer Involving the Lower Respiratory Tract

Abstract Background Hemoptysis is a common presenting symptom of infectious, malignant, and vascular diseases. Its severity varies from chronic and stable, to acute and life-threatening. Malignancy involving the respiratory tree, including primary lung and metastatic cancer, is a common cause of both new and recurrent hemoptysis. However, little is known about factors that may predispose to recurrent hemoptysis after initial presentation in this population. Methods We conducted a retrospective cohort study of patients with lower respiratory tract malignancy who presented to the emergency department with hemoptysis or developed hemoptysis during admission. We identified and screened this population through a query of medical records, utilizing ICD-9 and ICD-10 codes for hemoptysis and cancers of the respiratory tract. (ICD-9: R04.2 and C34, ICD-10: 786.30 and 162.9). Demographic, imaging, and bronchoscopic data were extracted for patients treated between 2014 and 2024 and compared between those with recurrent hemoptysis (with documented cessation for 7 days or separate hospitalization) and those without a documented episode of recurrence. Analysis was conducted on the first 200 patients who met inclusion criteria. Results Two-hundred patients with hemoptysis episodes in the context of known or new malignancy of the lower respiratory tract were included. Fifty-three patients (26.5%) had recurrent hemoptysis, and 147 (73.5%) had no recurrence. The median age was 67 years (IQR 59-75) for both groups. The median time to recurrence was 64.5 days; 33 patients recurred within 100 days, and 16 within 35 days. Risk factors were evaluated for statistical significance. Lack of cancer directed therapy, tumor size, restarting anticoagulation post procedure, hemoptysis refractory to treatment were significantly associated to hemoptysis recurrence. Current radiotherapy and tumor not involving the central airway were protective factors against recurrence. Conclusion Recurrent hemoptysis is expected in approximately 25% of patients with lower respiratory tract cancer, with most episodes occurring within 100 days of initial presentation. Identified risk factors for recurrence include lack of cancer treatment, tumor size, persistent hemoptysis post-bronchoscopy, and restarting therapeutic anticoagulation. Current radiotherapy and absence of malignant involvement of central airways on radiography may be protective against recurrent hemoptysis. With validation in a larger, potentially multicentric population, these findings could inform development of a risk stratification tool to help identify patients with malignancy of the respiratory tract at higher risk for hemoptysis recurrence, as well as guide management decisions. This abstract is funded by: None