Effectiveness of corticosteroid in diffuse alveolar hemorrhage with hematologic malignancy

Diffuse alveolar hemorrhage (DAH) may occur with vasculitis, infection, and coagulation disorders. In patients with hematologic malignancies such as leukemia, lymphoma and multiple myeloma, the risk of death from DAH is 70%. Although their effectiveness remains uncertain, corticosteroids are the mainstay of treatment. It is not easy to determine the use of corticosteroids because of the adverse effects such as worsening of infections, gastrointestinal (GI) bleeding and poor blood glucose control. Retrospective analysis was performed at a single medical center in South Korea from August 2005 to April 2018. DAH was diagnosed by strict clinical criteria and the presence of progressively bloodier return on bronchoalveolar lavage. 49 patients had alveolar hemorrhage (26 with non-infection associated hemorrhage(IAH), 23 with IAH). Patients who received corticosteroids had 60-day survival of 31% (95% CI, 25%–39%), compared with 33% (95% CI, 21%–45%) for those who did not (P=0.78). There are no differences about mortality rate, weaning rate of mechanical ventilator, intensive care unit (ICU) stay, hospital length of stay and complications(ventilator associated pneumonia, GI bleeding and catheter related blood stream infection). Naturally, the insulin requirement was high in the corticosteroid treatment group. Regardless of infection in alveolar hemorrhage with hematologic malignancy, the survival rate did not increase or the ICU stay did not decrease in the steroid treatm...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Rare ILD/DPLD Source Type: research