Prognosis

There are no clinical or radiographic findings which can accurately predict the appearance of massive hemoptysis; mortality varies between the extremes of 0.9 and 85 per cent, with the lower rates in more recent series (Stoller . . .1992). Prognosis is closely related to the rate of bleeding rather than to the extent of pulmonary disease or the age of the patient. In a series of 59 patients, the death rate was six times higher in patients coughing more than 1000 ml of blood every 24 h (58 per cent) than in patients with smaller-volume hemoptysis (9 per cent), with an overall mortality of 34.5 per cent ( Cgrey. and Hla 1987). Clinical features that exclude patients as surgical candidates (e.g. inadequate pulmonary function, debilitated states, bilateral pulmonary bleeding sources, metastatic cancer) are also strongly associated with increased mortality, for example a mortality of 46 per cent in inoperable patients versus 16 per cent in operable patients in the series reported by Corey.and Hla.

(1987). Appropriate interpretation of medical mortality among series requires comparison of mortality among patients deemed operable but managed medically. Thus the mortality in the surgical candidates managed medically in the series of Corey..and Hla..i..1.987.) was 11 per cent compared with 29 per cent of all medically managed patients (including some inoperable patients). Obviously, the impact of the underlying disease is more crucial than the impact of surgery and medical treatment.

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