Clinically significant hemoptysis and all-cause mortality in patients with nontuberculous mycobacterial pulmonary disease

Background: Hemoptysis is one of the major symptoms in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its prevalence, incidence, and impact on long-term prognosis remain uncertain. We evaluated the incidence of clinically significant hemoptysis, and determined its association with mortality in patients with NTM-PD.

Methods: Patients enrolled in a prospective observational cohort (NCT01616745) between July 2011 and May 2023 were analyzed. We evaluated risk factors for clinically significant hemoptysis-defined as hemoptysis events requiring interventions such as bronchial artery embolization or surgical resection -and its association with all-cause mortality.

Results: Among 506 patients from the ongoing cohort, 43 patients (8.5%) experienced clinically significant hemoptysis during a median follow-up of 5.1 years. The overall incidence of clinically significant hemoptysis was 2.1 (95% confidence interval [CI]; 1.5-2.9) cases per 100 person-years. Identified risk factors included a history of tuberculosis (incidence rate ratio [IRR], 1.91; 95% CI, 1.02-3.60), higher c-reactive protein (CRP) (IRR, 1.20 for 1mg/dl increase; 95% CI, 1.01-1.43), and lower % predicted forced vital capacity (FVC) (IRR, 0.81 for 10% increase; 95% CI, 0.66-0.98). Clinically significant hemoptysis was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 2.39; 95% CI, 1.31-4.36).

Conclusion: In patients with NTM-PD, those with history of tuberculosis, higher CRP levels, and lower % predicted FVC were at a higher risk of subsequent clinically significant hemoptysis. Importantly, clinically significant hemoptysis was associated with an elevated risk of all-cause mortality.

Clinical trial registration: ClinicalTrials.gov; No.: NCT01616745.