Evaluation of the ability of hemostatic agents to prevent hemoptysis during ultrasound-guided lung biopsy.

BACKGROUND

Low-dose computed tomography screening has substantially improved the detection of peripheral pulmonary lesions (PPLs). Ultrasound-guided lung biopsy is widely used for diagnosis; however, postoperative hemoptysis is a critical complication, and the value of routine prophylactic hemostasis remains unclear. This study aimed to investigate the risk factors for hemoptysis following ultrasound-guided percutaneous lung biopsy and evaluate the advantages and disadvantages of prophylactic hemostatic agents in high- and low-risk patients.

METHODS

A total of 697 patients who underwent ultrasound-guided peripheral lung biopsy were retrospectively enrolled in this study. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative hemoptysis, and receiver operating characteristic curve analysis was used to determine the optimal cutoff value for lesion thickness. Subsequently, 126 patients were prospectively recruited and randomly divided into four subgroups: high-risk with hemostatic agents, high-risk without hemostatic agents, low-risk with hemostatic agents, and low-risk without hemostatic agents. Quantitative perioperative indicators, including hemoptysis incidence and volume, blood oxygen saturation, pulse rate, hemoglobin, platelet count, and coagulation function indices, were statistically compared among groups, and hemostatic agent-related adverse complications were recorded.

RESULTS

The overall post-biopsy hemoptysis rate was 9.03% (63/697). Multivariate regression analysis confirmed that lesion thickness <15 mm and grade 2 air bronchial signs were independent risk factors for hemoptysis (all P<0.05). The optimal cutoff value of lesion thickness was 15 mm, with an area under the curve (AUC) of 0.713, a sensitivity of 92.4%, and a specificity of 52.4%. For high-risk patients, prophylactic hemostatic agents significantly reduced the hemoptysis rate (15.15% vs. 39.29%, P=0.034) and hemoptysis volume (P=0.014), and effectively stabilized postoperative blood oxygen saturation, compared with the non-hemostatic group. In low-risk patients, no significant differences in hemoptysis incidence, hemoptysis volume, or blood oxygen saturation were observed between patients who received hemostatic agents and those who did not (all P>0.05). Additionally, no significant differences between pre- and postoperative measurements were observed in pulse rate, hemoglobin level, platelet count, or any coagulation index across all subgroups (all P>0.05). The incidence of hemostatic agent-related adverse reactions was 7.58% (5/66), and all adverse symptoms were relieved after symptomatic treatment.

CONCLUSIONS

Lesion thickness <15 mm and grade 2 air bronchial signs were identified as independent risk factors for hemoptysis following ultrasound-guided biopsy of PPLs. Prophylactic hemostatic agents may help reduce the hemoptysis rate and volume in patients with at least one high-risk factor. However, given the moderate predictive performance of these risk factors (AUC =0.713), individualized clinical judgment remains essential.