Krwawienie z nosa – Rokowania, prognozy i postęp choroby

Krwawienie z nosa
Rokowania, prognozy i postęp choroby

Rokowanie w przypadku epistaxis jest generalnie dobre, choć zależy od etiologii, chorób współistniejących oraz zastosowanego leczenia. U większości pacjentów krwawienia z nosa są samoograniczające i nie powodują poważnych następstw, jednak u osób starszych, z chorobami współistniejącymi lub przyjmujących leki przeciwzakrzepowe może dojść do powikłań, takich jak hipowolemia czy infekcje po tamponowaniu. Szczególną uwagę wymaga dziedziczna teleangiektazja krwotoczna (HHT), gdzie nawroty krwawień są częste i wymagają monitorowania za pomocą narzędzi takich jak Epistaxis Severity Score (ESS) z minimalną istotną różnicą (MID) na poziomie 0,71. W leczeniu stosuje się metody od ucisku i kauteryzacji po tamponowanie i interwencje chirurgiczne, zwłaszcza w przypadku krwawień tylnych, które są rzadsze, ale bardziej niebezpieczne. Ankieta NOSE HHT stanowi zwalidowane narzędzie do oceny wpływu krwawień na jakość życia i efektywności terapii u pacjentów z HHT.

Prognosis nosebleedów – spojrzenie ogólne
Czynniki prognostyczne w krwawieniach z nosa

Odpowiedź na leczenie jako czynnik prognostyczny
Rokowanie w zależności od typu krwawienia

Narzędzia oceny prognostycznej w krwawieniach z nosa

Skala nasilenia krwawienia z nosa (ESS)
Skala NOSE HHT

Rokowanie długoterminowe i ryzyko chorób współistniejących

Ryzyko nowotworowe u pacjentów z krwawieniami z nosa
Kolejne rozdziały

Prognosis nosebleedów – spojrzenie ogólne

Rokowanie w przypadku krwawień z nosa (epistaxis) jest zazwyczaj dobre, choć może być zmienne w zależności od przyczyny krwawienia, chorób współistniejących oraz zastosowanego leczenia. Dla większości populacji ogólnej, krwawienie z nosa stanowi jedynie niedogodność, jednak w niektórych przypadkach może zagrażać życiu, szczególnie u osób starszych i pacjentów z chorobami współistniejącymi. Na szczęście śmiertelność jest rzadka i zwykle wynika z powikłań związanych z hipowolemią, ciężkim krwawieniem lub chorobami podstawowymi.¹

Przy odpowiednim leczeniu, rokowanie jest doskonałe. Gdy zapewniona jest właściwa opieka i kontrolowane są podstawowe problemy medyczne, u większości pacjentów mało prawdopodobne jest wystąpienie ponownego krwawienia. U niektórych mogą wystąpić drobne nawroty, które ustępują samoistnie lub po minimalnym samoleczeniu. Niewielki odsetek pacjentów może wymagać ponownego tamponowania lub bardziej agresywnych metod leczenia.²

Czynniki prognostyczne w krwawieniach z nosa

Rokowanie w krwawieniach z nosa zależy od kilku kluczowych czynników. Pacjenci z krwawieniami z nosa spowodowanymi suchą błoną śluzową lub niewielkim urazem zwykle radzą sobie dobrze, bez długotrwałych następstw. Natomiast pacjenci z dziedziczną teleangiektazją krwotoczną (HHT) mają tendencję do licznych nawrotów, niezależnie od zastosowanej metody leczenia. Pacjenci z krwawieniami wynikającymi z problemów hematologicznych lub nowotworów mają zmienne rokowanie.³

Pacjenci, którzy przeszli tamponowanie nosa, są narażeni na zwiększoną chorobowość. Tamponowanie tylne może potencjalnie powodować zaburzenia drożności dróg oddechowych i depresję oddechową. Tamponowanie w dowolnej lokalizacji może prowadzić do infekcji.⁴

Odpowiedź na leczenie jako czynnik prognostyczny

Przy odrobinie cierpliwości i zastosowaniu odpowiedniego ucisku, prawie wszystkie niepowikłane krwawienia z nosa reagują na proste środki pierwszej pomocy. Nawet krwawienie z nosa wymagające opieki lekarskiej zwykle może być skutecznie leczone poprzez kauteryzację, tamponowanie lub inne opcje terapeutyczne.⁵

Niektóre osoby z nadmiernym krwawieniem, wieloma problemami medycznymi lub przyjmujące leki przeciwzakrzepowe mogą wymagać hospitalizacji w celu leczenia krwawienia z nosa.⁶ Leczenie poważnego krwawienia z nosa lub krwawień przewlekłych jest wysoce zindywidualizowane.⁷

Rokowanie w zależności od typu krwawienia

Krwawienia tylne (do tylnej części nosa) i krwawienia nieodpowiadające na leczenie niechirurgiczne mogą wymagać interwencji chirurgicznej.⁸ Krwawienia tylne są znacznie mniej powszechne niż krwawienia przednie i wymagają natychmiastowej pomocy medycznej, ponieważ mogą sygnalizować istniejącą chorobę podstawową.⁹

Według specjalistów, przy odpowiedniej opiece doświadczonego specjalisty, osoby leczone z powodu krwawień z nosa i związanych z nimi powikłań mogą oczekiwać doskonałego rokowania.¹⁰

Narzędzia oceny prognostycznej w krwawieniach z nosa

Skala nasilenia krwawienia z nosa (ESS)

Epistaxis Severity Score (ESS) to narzędzie internetowe używane do oceny aktualnego nasilenia krwawień z nosa u pacjentów z HHT (zwykle w ciągu ostatnich trzech miesięcy) i może pomóc pracownikom służby zdrowia w ocenie odpowiedzi pacjenta na leczenie. Wartość ESS pacjenta może pomóc lekarzom ocenić najskuteczniejsze leczenie krwawień z nosa związanych z HHT.¹¹

Istotna klinicznie różnica (minimal important difference, MID) dla skali ESS została określona na poziomie 0,71. MID jest ważna dla monitorowania progresji objawów HHT u pacjentów i pomaga w ustaleniu najlepszego sposobu leczenia. Oznacza to, że jeśli wartość ESS pacjenta wzrosła o co najmniej 0,71, krwawienia z nosa znacznie zwiększyły swoją intensywność, co może oznaczać, że obecne leczenie lub terapia nie jest skuteczna. Z drugiej strony, jeśli wynik zmniejszył się o co najmniej 0,71, krwawienia z nosa znacznie zmniejszyły swoją intensywność, co może sugerować, że obecne leczenie krwawień działa dobrze i powinno być kontynuowane.¹²

Skala NOSE HHT

Badania wykazały, że Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT) zapewnia klinicystom zwalidowaną miarę fizycznych, funkcjonalnych i emocjonalnych konsekwencji krwawień z nosa związanych z HHT i może być stosowana jako miara wyników w przyszłych badaniach klinicznych dotyczących krwawień z nosa.¹³

Ocena spójności, wiarygodności i responsywności ankiety NOSE HHT wykazała, że jest to ważny instrument do oceny nasilenia i zmian w krwawieniach z nosa. Dwutygodniowy przedział referencyjny NOSE HHT pozwala na monitorowanie krwawień z nosa co dwa tygodnie, co umożliwia określenie ram czasowych, w których dana interwencja przynosi efekt – podejście rutynowo stosowane w dużych badaniach przewlekłego zapalenia zatok przynosowych, wielokrotnie oceniających zmiany w powszechnie używanym 20-punktowym teście wyników nosa i zatok (SNOT-22).¹⁴

Wyniki badań sugerują, że ankieta NOSE HHT spełnia potrzebę istotnej klinicznie, zwalidowanej, wiarygodnej i responsywnej miary wyników do stosowania przez lekarzy w badaniach klinicznych i podczas leczenia pacjentów z HHT.¹⁵

Rokowanie długoterminowe i ryzyko chorób współistniejących

Ryzyko nowotworowe u pacjentów z krwawieniami z nosa

Badania wykazują, że krwawienia z dróg oddechowych, w tym krwawienia z nosa, mogą być markerem raka. Analizy ilościowe ryzyka określonych typów nowotworów u pacjentów z rozpoznaniami szpitalnymi krwawień z nosa i krwioplucia dostarczają istotnych danych prognostycznych.¹⁶

Bezwzględne ryzyko wystąpienia jakiegokolwiek nowotworu w ciągu 90 dni wynosiło 0,59% w kohorcie pacjentów z krwawieniem z nosa i 3,78% w kohorcie pacjentów z krwiopluciem. Odpowiadające im standaryzowane wskaźniki zachorowalności (SIR) wynosiły odpowiednio 1,85 (95% przedział ufności (CI) 1,69-2,02) i 14,6 (95% CI 13,5-15,7). Ryzyko zachorowania na raka stale zmniejszało się w czasie, ale utrzymywało się ponad 5 lat po wystąpieniu obu stanów.¹⁷

W badaniach zaobserwowano 9173 przypadki nowotworów w porównaniu z oczekiwanymi 7737 wśród pacjentów z krwawieniami z nosa oraz 2582 nowotwory w porównaniu z oczekiwanymi 1540 wśród pacjentów z krwiopluciem. Ogólny SIR wynosił 1,19 (95% CI 1,16-1,21) dla krwawień z nosa i 1,68 (95% CI 1,61-1,74) dla krwioplucia. SIR wynosił 1,85 (95% CI 1,69-2,02) w ciągu pierwszych 90 dni po rozpoznaniu krwawienia z nosa i 14,6 (95% CI 13,5-15,7) w ciągu pierwszych 90 dni po rozpoznaniu krwioplucia.¹⁸

Badania wykazały, że pacjenci z rozpoznaniem szpitalnym krwawień z nosa, a szczególnie krwioplucia, mieli zwiększone ryzyko zachorowania na raka w porównaniu z ogólną populacją. Ryzyko względne było szczególnie wysokie w przypadku raka hematologicznego po krwawieniu z nosa oraz nowotworów związanych z paleniem tytoniu i spożywaniem alkoholu po krwiopluciu. Związek z rakiem utrzymywał się przez ponad 5 lat po początkowym epizodzie krwawienia.¹⁹

Kolejne rozdziały

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Materiały źródłowe

#1 Epistaxis: Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/863220-overview
Prognosis […] For most of the general population, epistaxis is merely a nuisance. However, the problem can occasionally be life-threatening, especially in elderly patients and in those patients with underlying medical problems. Fortunately, mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states. […] Overall, the prognosis is good but variable; with proper treatment, it is excellent. When adequate supportive care is provided and underlying medical problems are controlled, most patients are unlikely to experience any rebleeding. Others may have minor recurrences that resolve spontaneously or with minimal self-treatment. A small percentage of patients may require repacking or more aggressive treatments. […] Patients with epistaxis that occurs from dry membranes or minor trauma do well, with no long-term effects. Patients with HHT tend to have multiple recurrences regardless of the treatment modality. Patients with bleeding from a hematologic problem or cancer have a variable prognosis. Patients who have undergone nasal packing are subject to increased morbidity. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.
#2 Epistaxis: Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/863220-overview
Prognosis […] For most of the general population, epistaxis is merely a nuisance. However, the problem can occasionally be life-threatening, especially in elderly patients and in those patients with underlying medical problems. Fortunately, mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states. […] Overall, the prognosis is good but variable; with proper treatment, it is excellent. When adequate supportive care is provided and underlying medical problems are controlled, most patients are unlikely to experience any rebleeding. Others may have minor recurrences that resolve spontaneously or with minimal self-treatment. A small percentage of patients may require repacking or more aggressive treatments. […] Patients with epistaxis that occurs from dry membranes or minor trauma do well, with no long-term effects. Patients with HHT tend to have multiple recurrences regardless of the treatment modality. Patients with bleeding from a hematologic problem or cancer have a variable prognosis. Patients who have undergone nasal packing are subject to increased morbidity. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.
#3 Epistaxis: Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/863220-overview
Prognosis […] For most of the general population, epistaxis is merely a nuisance. However, the problem can occasionally be life-threatening, especially in elderly patients and in those patients with underlying medical problems. Fortunately, mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states. […] Overall, the prognosis is good but variable; with proper treatment, it is excellent. When adequate supportive care is provided and underlying medical problems are controlled, most patients are unlikely to experience any rebleeding. Others may have minor recurrences that resolve spontaneously or with minimal self-treatment. A small percentage of patients may require repacking or more aggressive treatments. […] Patients with epistaxis that occurs from dry membranes or minor trauma do well, with no long-term effects. Patients with HHT tend to have multiple recurrences regardless of the treatment modality. Patients with bleeding from a hematologic problem or cancer have a variable prognosis. Patients who have undergone nasal packing are subject to increased morbidity. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.
#4 Epistaxis: Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/863220-overview
Prognosis […] For most of the general population, epistaxis is merely a nuisance. However, the problem can occasionally be life-threatening, especially in elderly patients and in those patients with underlying medical problems. Fortunately, mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states. […] Overall, the prognosis is good but variable; with proper treatment, it is excellent. When adequate supportive care is provided and underlying medical problems are controlled, most patients are unlikely to experience any rebleeding. Others may have minor recurrences that resolve spontaneously or with minimal self-treatment. A small percentage of patients may require repacking or more aggressive treatments. […] Patients with epistaxis that occurs from dry membranes or minor trauma do well, with no long-term effects. Patients with HHT tend to have multiple recurrences regardless of the treatment modality. Patients with bleeding from a hematologic problem or cancer have a variable prognosis. Patients who have undergone nasal packing are subject to increased morbidity. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.
#5 Nosebleed (Epistaxis) – Harvard Health
https://www.health.harvard.edu/a_to_z/nosebleed-epistaxis-a-to-z
With a little patience and pressure, almost all uncomplicated nosebleeds respond to simple first-aid measures. […] Even the nosebleed that requires a doctor’s care usually can be treated successfully with cauterization, packing or other options. […] Some people who have excessive bleeding, multiple medical problems or who are taking anticoagulant medications may need to be hospitalized for treatment of a nosebleed.
#6 Nosebleed (Epistaxis) – Harvard Health
https://www.health.harvard.edu/a_to_z/nosebleed-epistaxis-a-to-z
With a little patience and pressure, almost all uncomplicated nosebleeds respond to simple first-aid measures. […] Even the nosebleed that requires a doctor’s care usually can be treated successfully with cauterization, packing or other options. […] Some people who have excessive bleeding, multiple medical problems or who are taking anticoagulant medications may need to be hospitalized for treatment of a nosebleed.
#7 Nosebleeds (Epistaxis) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/epistaxis
Nosebleeds occur when a blood vessel inside your nose bursts. […] If you have chronic nosebleeds, it’s a good idea to be evaluated by a specialist, says Peter Manes, MD, a Yale Medicine otolaryngologist. […] Posterior nosebleeds are far less common than anterior nosebleeds and they require prompt medical attention because they can signal an underlying medical condition. […] Some nosebleeds require immediate emergency care. […] Treatment of a serious nosebleed or chronic ones is highly individualized. […] Posterior nosebleeds (toward the back of the nose) and nosebleeds that don’t respond to nonsurgical treatments may require surgery. […] Dr. Manes says that with proper care from an experienced specialist, people who are treated for nosebleeds and related complications can expect an excellent prognosis.
#8 Nosebleeds (Epistaxis) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/epistaxis
Nosebleeds occur when a blood vessel inside your nose bursts. […] If you have chronic nosebleeds, it’s a good idea to be evaluated by a specialist, says Peter Manes, MD, a Yale Medicine otolaryngologist. […] Posterior nosebleeds are far less common than anterior nosebleeds and they require prompt medical attention because they can signal an underlying medical condition. […] Some nosebleeds require immediate emergency care. […] Treatment of a serious nosebleed or chronic ones is highly individualized. […] Posterior nosebleeds (toward the back of the nose) and nosebleeds that don’t respond to nonsurgical treatments may require surgery. […] Dr. Manes says that with proper care from an experienced specialist, people who are treated for nosebleeds and related complications can expect an excellent prognosis.
#9 Nosebleeds (Epistaxis) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/epistaxis
Nosebleeds occur when a blood vessel inside your nose bursts. […] If you have chronic nosebleeds, it’s a good idea to be evaluated by a specialist, says Peter Manes, MD, a Yale Medicine otolaryngologist. […] Posterior nosebleeds are far less common than anterior nosebleeds and they require prompt medical attention because they can signal an underlying medical condition. […] Some nosebleeds require immediate emergency care. […] Treatment of a serious nosebleed or chronic ones is highly individualized. […] Posterior nosebleeds (toward the back of the nose) and nosebleeds that don’t respond to nonsurgical treatments may require surgery. […] Dr. Manes says that with proper care from an experienced specialist, people who are treated for nosebleeds and related complications can expect an excellent prognosis.
#10 Nosebleeds (Epistaxis) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/epistaxis
Nosebleeds occur when a blood vessel inside your nose bursts. […] If you have chronic nosebleeds, it’s a good idea to be evaluated by a specialist, says Peter Manes, MD, a Yale Medicine otolaryngologist. […] Posterior nosebleeds are far less common than anterior nosebleeds and they require prompt medical attention because they can signal an underlying medical condition. […] Some nosebleeds require immediate emergency care. […] Treatment of a serious nosebleed or chronic ones is highly individualized. […] Posterior nosebleeds (toward the back of the nose) and nosebleeds that don’t respond to nonsurgical treatments may require surgery. […] Dr. Manes says that with proper care from an experienced specialist, people who are treated for nosebleeds and related complications can expect an excellent prognosis.
#11 Nosebleed Severity Score – CureHHT
https://curehht.org/understanding-hht/diagnosis-treatment/nosebleed-severity-score/
The Epistaxis Severity Score (ESS)* is an online tool used to evaluate the current severity of HHT patient nosebleeds (typically in the last three months) and can help health care providers to evaluate how a patient is responding to treatment. […] A patient’s ESS can help doctors evaluate the most effective treatment for HHT-related nosebleeds. […] This value, called the minimal important difference (MID), was determined to be 0.71 (Yin et al. 2015). The MID is important for monitoring the progression of a patients HHT symptoms and helps to determine the best course of treatment. This would mean that if your ESS has increased by at least 0.71 that your nosebleeds have significantly increased in severity and could mean that the current treatment or therapy is not effective for you. On the other hand, if your score has decreased by at least 0.71 then your nosebleeds have significantly decreased in severity, and this might mean that your current epistaxis treatments are working well for you and should be continued.
#12 Nosebleed Severity Score – CureHHT
https://curehht.org/understanding-hht/diagnosis-treatment/nosebleed-severity-score/
The Epistaxis Severity Score (ESS)* is an online tool used to evaluate the current severity of HHT patient nosebleeds (typically in the last three months) and can help health care providers to evaluate how a patient is responding to treatment. […] A patient’s ESS can help doctors evaluate the most effective treatment for HHT-related nosebleeds. […] This value, called the minimal important difference (MID), was determined to be 0.71 (Yin et al. 2015). The MID is important for monitoring the progression of a patients HHT symptoms and helps to determine the best course of treatment. This would mean that if your ESS has increased by at least 0.71 that your nosebleeds have significantly increased in severity and could mean that the current treatment or therapy is not effective for you. On the other hand, if your score has decreased by at least 0.71 then your nosebleeds have significantly decreased in severity, and this might mean that your current epistaxis treatments are working well for you and should be continued.
#13 Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT)
https://pmc.ncbi.nlm.nih.gov/articles/PMC7530813/
This survey study uses data from a tertiary care center and online patient community to develop and assess the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia outcome measure of epistaxis in patients with hereditary hemorrhagic telangiectasia. […] The Nasal Outcome Score for Epistaxis in HHT outcome measure provides clinicians with a validated measurement of physical, functional, and emotional consequences of HHT-associated epistaxis and can be used as an outcome measure in future epistaxis clinical trials. […] Evaluation of the consistency, reliability, and responsiveness of the NOSE HHT survey found it to be a valid instrument to assess severity and change in epistaxis. […] From the consistency, reliability, and responsiveness of the NOSE HHT survey in our cohort, we propose that the NOSE HHT be used as an outcome measure in future HHT-associated epistaxis treatment trials. The 2-week reference interval of the NOSE HHT permits monitoring of epistaxis every 2 weeks to allow determination of the time frame in which a particular intervention takes its effect, an approach routinely used in large chronic rhinosinusitis trials repeatedly assessing change on the widely used 20-Item Sino-Nasal Outcome Test (SNOT-22). […] Our results suggest that the NOSE HHT survey fulfills the need for a clinically relevant, validated, reliable, and responsive outcome measure for use by physicians within clinical trials and when treating patients with HHT.
#14 Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT)
https://pmc.ncbi.nlm.nih.gov/articles/PMC7530813/
This survey study uses data from a tertiary care center and online patient community to develop and assess the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia outcome measure of epistaxis in patients with hereditary hemorrhagic telangiectasia. […] The Nasal Outcome Score for Epistaxis in HHT outcome measure provides clinicians with a validated measurement of physical, functional, and emotional consequences of HHT-associated epistaxis and can be used as an outcome measure in future epistaxis clinical trials. […] Evaluation of the consistency, reliability, and responsiveness of the NOSE HHT survey found it to be a valid instrument to assess severity and change in epistaxis. […] From the consistency, reliability, and responsiveness of the NOSE HHT survey in our cohort, we propose that the NOSE HHT be used as an outcome measure in future HHT-associated epistaxis treatment trials. The 2-week reference interval of the NOSE HHT permits monitoring of epistaxis every 2 weeks to allow determination of the time frame in which a particular intervention takes its effect, an approach routinely used in large chronic rhinosinusitis trials repeatedly assessing change on the widely used 20-Item Sino-Nasal Outcome Test (SNOT-22). […] Our results suggest that the NOSE HHT survey fulfills the need for a clinically relevant, validated, reliable, and responsive outcome measure for use by physicians within clinical trials and when treating patients with HHT.
#15 Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT)
https://pmc.ncbi.nlm.nih.gov/articles/PMC7530813/
This survey study uses data from a tertiary care center and online patient community to develop and assess the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia outcome measure of epistaxis in patients with hereditary hemorrhagic telangiectasia. […] The Nasal Outcome Score for Epistaxis in HHT outcome measure provides clinicians with a validated measurement of physical, functional, and emotional consequences of HHT-associated epistaxis and can be used as an outcome measure in future epistaxis clinical trials. […] Evaluation of the consistency, reliability, and responsiveness of the NOSE HHT survey found it to be a valid instrument to assess severity and change in epistaxis. […] From the consistency, reliability, and responsiveness of the NOSE HHT survey in our cohort, we propose that the NOSE HHT be used as an outcome measure in future HHT-associated epistaxis treatment trials. The 2-week reference interval of the NOSE HHT permits monitoring of epistaxis every 2 weeks to allow determination of the time frame in which a particular intervention takes its effect, an approach routinely used in large chronic rhinosinusitis trials repeatedly assessing change on the widely used 20-Item Sino-Nasal Outcome Test (SNOT-22). […] Our results suggest that the NOSE HHT survey fulfills the need for a clinically relevant, validated, reliable, and responsive outcome measure for use by physicians within clinical trials and when treating patients with HHT.
#16 Risk of cancer in patients with epistaxis and haemoptysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5886125/
Respiratory tract bleeding may be a marker of cancer. We quantified the risk of specific cancer types among patients with hospital-based diagnoses of epistaxis and haemoptysis relative to risk in the general population. The 90-day absolute risk of any cancer was 0.59% in the epistaxis cohort and 3.78% in the haemoptysis cohort. The corresponding SIRs were 1.85 (95% confidence interval (CI) 1.69, 2.02) and 14.6 (95% CI 13.5, 15.7), respectively. The cancer risk decreased steadily over time, but persisted beyond 5 years of follow-up after both conditions. Epistaxis and particular haemoptysis may be markers of cancer at several sites. […] We observed 9173 cancers compared with 7737 expected among patients with epistaxis, and 2582 cancers compared with 1540 expected among patients with haemoptysis.
#17 Risk of cancer in patients with epistaxis and haemoptysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5886125/
Respiratory tract bleeding may be a marker of cancer. We quantified the risk of specific cancer types among patients with hospital-based diagnoses of epistaxis and haemoptysis relative to risk in the general population. The 90-day absolute risk of any cancer was 0.59% in the epistaxis cohort and 3.78% in the haemoptysis cohort. The corresponding SIRs were 1.85 (95% confidence interval (CI) 1.69, 2.02) and 14.6 (95% CI 13.5, 15.7), respectively. The cancer risk decreased steadily over time, but persisted beyond 5 years of follow-up after both conditions. Epistaxis and particular haemoptysis may be markers of cancer at several sites. […] We observed 9173 cancers compared with 7737 expected among patients with epistaxis, and 2582 cancers compared with 1540 expected among patients with haemoptysis.
#18 Risk of cancer in patients with epistaxis and haemoptysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5886125/
The overall SIR was 1.19 (95% CI 1.16, 1.21) for epistaxis and 1.68 (95% CI 1.61, 1.74) for haemoptysis. The SIRs were 1.85 (95% CI 1.69, 2.02) during the first 90 days following an epistaxis diagnosis and 14.6 (95% CI 13.5, 15.7) during the first 90 days following a haemoptysis diagnosis. […] In conclusion, we found that patients with a hospital diagnosis of epistaxis and particularly haemoptysis were at increased risk of cancer compared with the Danish general population. The relative risks were particularly high for haematological cancer after epistaxis, and of smoking and alcohol-related cancers after haemoptysis. The association with cancer persisted for more than 5 years after the initial bleeding event.
#19 Risk of cancer in patients with epistaxis and haemoptysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5886125/
The overall SIR was 1.19 (95% CI 1.16, 1.21) for epistaxis and 1.68 (95% CI 1.61, 1.74) for haemoptysis. The SIRs were 1.85 (95% CI 1.69, 2.02) during the first 90 days following an epistaxis diagnosis and 14.6 (95% CI 13.5, 15.7) during the first 90 days following a haemoptysis diagnosis. […] In conclusion, we found that patients with a hospital diagnosis of epistaxis and particularly haemoptysis were at increased risk of cancer compared with the Danish general population. The relative risks were particularly high for haematological cancer after epistaxis, and of smoking and alcohol-related cancers after haemoptysis. The association with cancer persisted for more than 5 years after the initial bleeding event.