Clinical profiles and mortality risk factors in pediatric pulmonary hemorrhage: a singlecenter study in Saudi Arabia

Abstract

Background: Pulmonary hemorrhage (PH) is a rare, life-threatening event characterized by bleeding into the airways and lung parenchyma.

Objectives: To explore the clinical characteristics of PH patients and investigate mortality-related risk factors, providing a holistic understanding of patient outcomes in this population.

Design: A retrospective cohort study.

Settings: The Pediatric Intensive Care Unit (PICU) at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.

Patients and methods: Pediatric patients with PH episodes (aged 1 month to 14 years) who were admitted from January 2014 to September 2019.

Main outcomes measures: Clinical characteristics, outcomes, and mortality-related risk factors.

Sample size: 80 children.

Results: The cohort had a sex ratio of 1:1 and a median age of 24 months [interquartile range: 9-78]. Medical histories included bone marrow transplant (51.3%), oncology cases (40.0%), chemotherapy (61.3%), chest infection (86.3%), and immunosuppressant use (71.3%). Additionally, most patients (87.5%) had acute respiratory distress syndrome during the PH episode. The overall PICU mortality rate was 82.5% (66/80), and was associated with thrombocytopenia, sepsis, renal impairment, liver dysfunction, multiorgan dysfunction, and altered code status in univariable analysis (all P <.05). Multivariate analysis identified sepsis, multiorgan dysfunction, and altered code status as key predictors of PICU mortality (P <.05).

Conclusion: The high mortality rate reported emphasizes the need for tailored interventions and heightened vigilance, particularly in immunocompromised children. Future research will expand on these findings to refine current management protocols and further improve patient care in pediatric PH.

Limitations: Retrospective study, single-center.

Keywords: acute respiratory distress syndrome; hemoptysis; intensive care unit; pediatric; pulmonary hemorrhage.

Figure 1.

Flowchart of pediatric patients with PH treated in PICU between January 2014 and September 2019.

Figure 2.

Microorganisms identified among patients.

Figure 3.

Kaplan–Meier curve illustrating survival time from the PH episode to PICU discharge, comparing ARDS versus non-ARDS patients. The numbers in parentheses indicate deaths for each period.