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

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.