Prediction of 3-Year Recurrence of Hemoptysis After Bronchial Artery Embolization in Bronchiectasis Patients Using the Computed Tomography Bronchiectasis Score

Background Recurrent hemoptysis after bronchial artery embolization (BAE) in patients with bronchiectasis remains a major clinical challenge. The Computed Tomography Bronchiectasis Score (CTBS) quantifies disease severity based on radiological characteristics. This study aims to assess the prognostic value of CTBS in predicting the 3-year recurrence of hemoptysis following BAE in patients with bronchiectasis. Methods This retrospective cohort study included 121 patients who underwent BAE for bronchiectasis-related hemoptysis from January 2018 to December 2021. The association between CTBS and recurrence was assessed using restricted cubic splines (RCS) analysis, Kaplan-Meier (KM) analysis, and subgroup analysis. The importance of the potential risk factors was assessed using the Boruta algorithm and acceptable variables including CTBS were subsequently incorporated into the model construction. Results During the follow-up period, 53 patients (43.8%) experienced hemoptysis recurrence, while 68 (56.2%) remained recurrence-free. The recurrence group had significantly higher CTBS levels (P < 0.001). RCS analysis demonstrated a significant association between CTBS and 3-year recurrence, with higher CTBS levels linked to increased recurrence risk. The unadjusted hazard ratio (HR) for CTBS was 2.82 (95% CI: 1.64–4.68, P < 0.001), while the adjusted HR was 2.09 (95% CI: 1.13–3.86, P = 0.018). Subgroup analysis indicated that this association was independent of demographics, comorbidities, and other radiological features (P for interaction > 0.05). The optimal CTBS cut-off value was 11.5. The predictive model incorporating CTBS, developed using the Boruta algorithm, achieved an Area Under the Curve (AUC) of 0.809 (95% CI: 0.731–0.887), a concordance index (C-index) of 0.83, and a Brier Score of 0.171. The calibration curve showed good predictive accuracy, while decision curve analysis (DCA) and clinical impact curve (CIC) confirmed the model’s strong discriminatory ability and clinical relevance. Conclusions CTBS is a valuable prognostic tool for predicting the 3-year recurrence of hemoptysis in bronchiectasis patients following BAE. The predictive models incorporating CTBS can aid clinicians in identifying high-risk patients and developing personalized treatment strategies.