Predictive mortality factors of Diffuse Alveolar Hemorrhage: a retrospective study in Tunisia

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Background: Diffuse Alveolar Hamorrhage (DAH) is a life-threatening and medical emergency. It causes an acute respiratory failure, sometimes leading to death. Early bronchoscopy and Bronchoalveolar lavage (BAL) are keystones for diagnosis. Aim: to identify clinical and radiologic mortality factors of DAH among reanimation patients Methods: It was a retrospective case control study. It was conducted from January 2009 to December 2018 in the departments of intensive care units (ICU) and radiology in the hospital of pulmonary diseases Abderrahmane Mami in Ariana, Tunisia. Eligible patients were those having Intra Alveolar Hemorrhage (IAH) confirmed by Broncho Alveolar Lavage (BAL) and those who underwent a computed tomography (CT) of the chest. Data was taken from medical records. Data was analyzed by SPSS version 24. Univariate and multivariate analysis (logistic regression) were performed to identify independent predictive mortality factors. Results: Fifty-nine patients were included in the study. Sex ratio (M/F) was 1.24. Mean age was 48.6 years +/−50.43. Median stay at ICU was 11 days. Forty-one percent had invasive ventilation. One third of the patients were dead in the ICU. Logistic regression found that ratio PaO2/FiO2 <= 100mmHg and invasive ventilation were two independent mortality factors ((AOR = 14.7, 95%CI=[2.06-104.85], p=0.07) and (AOR=11.2, 95%CI=[2.56-49.58],p=0.01), respectively. Conclusion: DAH is a serious complication of multiple disorders. We found that ratio PaO2/FiO2 and invasive ventilation were possible mortality factors. A systemic approach to early diagnosis and treatment could decreased morbidity and mortality

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