Computed Tomography-Proven Active Bleeding with Negative Emergency Angiography: Early Mortality Predictors and...

Area of Science:

• Radiology and Imaging
• Emergency Medicine
• Critical Care Medicine

Background:

• Computed tomography (CT) is crucial for diagnosing active bleeding.
• Negative emergency angiography in CT-proven bleeding cases presents a unique clinical challenge.
• These patients face significant risks of mortality and rebleeding.

Purpose of the Study:

• To identify predictors of 30-day mortality in patients with CT-proven active bleeding and negative emergency angiography.
• To develop a simple bedside risk score for early stratification of these patients.
• To improve clinical decision-making and patient outcomes.

Main Methods:

• Retrospective analysis of a single-center cohort (2012-2026) of adult patients.
• Inclusion criteria: CT-detected active bleeding and negative emergency angiography.
• Statistical methods included logistic regression (LASSO-penalized) and survival analysis.
• A risk score, NAB-L, was derived and validated for discrimination and calibration.

Main Results:

• 118 patients were included; 30-day mortality was 14.4% and rebleeding occurred in 33.9%.
• Independent predictors of mortality: hemoglobin nadir < 8 g/dL, arterial lactate > 2 mmol/L, and age > 70 years.
• The NAB-L score demonstrated good discrimination (AUC 0.854) and adequate calibration.
• Mortality increased significantly with higher NAB-L scores (0% for score 0-1 to 56% for score 5).

Conclusions:

• CT-positive/angiography-negative bleeding is associated with considerable early mortality and rebleeding.
• The NAB-L score offers a practical tool for early bedside risk stratification.
• External validation is recommended for the NAB-L score to confirm its generalizability.