Hemothorax in a Medical Intensive Care Unit: Incidence, Comorbidity and Prognostic Factors

Background/Purpose: There is a lack of data regarding the occurrence of hemothorax in medical intensive care units (ICUs). The purpose of this study was to investigate the incidence, comorbidity and prognostic factors of hemothorax in medical ICU patients. Methods: From January 1997 to December 2004, patients with hemothorax that developed during an ICU stay were studied. Hemothorax was considered procedure-related if it developed within 24 hours after an invasive procedure. Medical records were reviewed and analyzed with respect to patients' demographic data, underlying diseases, reasons for admission, Acute Physiology and Chronic Health Evaluation II score, procedures related to hemothorax, management, duration of ICU stay, and outcomes. Results: Fifty-three patients (0.79%) suffered hemothorax during their ICU stay. Chronic kidney disease (77.4%) was the most common comorbidity. A total of 40 cases (75.5%) were procedure-related. Thoracentesis and chest tube thoracostomy were the most common procedures. The 28-day mortality rate was 35.8%. Multivariate logistic regression analysis revealed that a prothrombin time/international normalized ratio >= 1.6 (odds ratio = 10.99, 95% confidence interval = 1.08-112.05) and a hemoglobin decrease >= 3 g/dL (odds ratio = 5.55, 95% confidence interval = 1.26-24.45) were significantly associated with 28-day mortality. Conclusion: Chronic kidney disease was the most common comorbidity associated with hemothorax. Patients with chronic kidney disease might require close observation for hemothorax after invasive procedures, such as thoracentesis and chest tube thoracostomy. Prolonged prothrombin time and decreased hemoglobin level might be of prognostic value for critically ill patients with hemothorax.