Destroyed lung contributes to the recurrence of hemoptysis after bronchial artery embolization in patients with post-tuberculosis bronchiectasis

Background Bronchiectasis has high rates of hemoptysis and recurrent hemoptysis, which is inconsistent among various etiologies. Idiopathic bronchiectasis and post-tuberculous bronchiectasis are two important etiologies in China, but the differences in clinical features and risk factors of recurrent hemoptysis have not been elucidated. Methods Patients hospitalized for idiopathic bronchiectasis or post-tuberculosis bronchiectasis were included. Patients were followed up for at least 24 months post-BAE. Demographic characteristics and clinical data were collected and analyzed between idiopathic bronchiectasis and post-tuberculosis bronchiectasis. Based on the outcomes of recurrent severe hemoptysis in patients with post-tuberculosis bronchiectasis, Cox regression models were used to identify risk factors for recurrence. Results Among 417 patients including 352 idiopathic bronchiectasis and 65 post-tuberculous bronchiectasis, 209 (50.1%) were females. Compared with the idiopathic group, the proportion of patients with female (54.5% vs. 26.2%, p<0.001), with sputum (79.5% vs. 36.9%, p<0.001), isolation of Pseudomonas aeruginosa (28.7% vs. 7.7%, p<0.001), and the number of bronchiectatic lobes≥3(98.3% vs 50.8%, p<0.001) were lower, and the proportion of destroyed lung (4.5% vs. 26.6%, p<0.001) and recurrence of severe hemoptysis (22.4% vs. 41.5%, p=0.001) were higher in the post-tuberculous group. Among patients with post-tuberculosis bronchiectasis, destroyed lung [HR: 3.2(1.1,9.1), p=0.026] and abnormal esophageal proper artery [HR: 2.8(1.1,7.0), p=0.032] were two independent risk factors for the recurrence of hemoptysis. Conclusions The recurrence rate of severe hemoptysis in patients with post-tuberculous bronchiectasis receiving BAE is high, and the proper esophageal artery should be actively evaluated and standardized treatment should be given.