998. Independent Association of Younger Age with Hemoptysis in Adults with Pulmonary Tuberculosis: An Indication of Pulmonary Damage Due to a Strong Host Immune Response
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Hemoptysis and pulmonary cavitation are often pathognomonic for pulmonary tuberculosis (PTB).  Although many patients with PTB may develop cavitary lesions only a proportion of those develop hemoptysis.  Massive hemoptysis is often due to mechanical erosion of an artery within or near a cavitary wall, whereas the pathophysiology and risk factors for mild to moderate hemoptysis are less well understood.  This study aims to identify independent risk factors for mild to moderate hemoptysis in PTB.

Methods: Retrospective cross-sectional study of patients aged 18-99 years with newly diagnosed PTB. Records of subjects diagnosed with culture-confirmed PTB between April 1999 and March 2005 at a New York City public hospital were reviewed.  The patients were dichotomized based on the presence of hemoptysis and compared via univariate analysis.  Multivariate logistical regression was used to identify the variables that were independently associated with hemoptysis.

Results: 194 subjects with PTB were identified. Of those, 44 (23%) reported active hemoptysis on presentation.  The patients’ age ranged from 18 – 79 years. In univariate analysis, those with hemoptysis were significantly younger compared to those without hemoptysis (mean age 35±11 vs. 41±12, respectively; p=0.003). In addition, subjects with hemoptysis were more likely to be undocumented (p=0.018) and to have had prolonged symptoms duration over 7 weeks (p=0.038).  However, in multivariate analysis younger age was the only variable independently associated with hemoptysis.  This association was significant for a continuously decreasing age per year or per decade (OR 1.59; 95% CI, 1.17 -2.16; p=0.003). When age was dichotomized the odds of having hemoptysis were almost 3 times higher for subjects <45 years old compared to those ≥ 45 years old (OR 2.88; 95% CI, 1.2 – 6.9; p=0.017).

Conclusion: Younger age is independently associated with hemoptysis in PTB.  This association suggests pulmonary damage secondary to a stronger inflammatory response in younger compared to older adults.  These findings suggest a role for immune modulators in treatment of hemoptysis in PTB which warrants evaluation in large randomized studies.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Giliane Joseph, MD, Infectious Diseases, Montefiore Medical Center, Bronx, NY and Jacqueline Achkar, MD, Albert Einstein College of Medicine, Bronx, NY

Disclosures:

G. Joseph, None

J. Achkar, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.