Shock index correlates with extravasation on angiographs of gastrointestinal hemorrhage: a logistics regression analysis

• Published in: Cardiovascular and interventional radiology 2007-09, Vol.30 (5), p.861-865
• Main Authors: Nakasone, Yutaka, Ikeda, Osamu, Yamashita, Yasuyuki, Kudoh, Kouichi, Shigematsu, Yoshinori, Harada, Kazunori
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Angiography; BIOMEDICAL RADIOGRAPHY; BLOOD PRESSURE; BLOOD VESSELS; Embolization, Therapeutic; Extravasation of Diagnostic and Therapeutic Materials - blood; Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging; Extravasation of Diagnostic and Therapeutic Materials - etiology; Extravasation of Diagnostic and Therapeutic Materials - physiopathology; Extravasation of Diagnostic and Therapeutic Materials - therapy; Female; Gastrointestinal Hemorrhage - blood; Gastrointestinal Hemorrhage - complications; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - physiopathology; Gastrointestinal Hemorrhage - therapy; HEMOGLOBIN; Hemoglobins - metabolism; HEMORRHAGE; Humans; Logistic Models; Male; Medical imaging; Medical research; Middle Aged; Models, Cardiovascular; MULTIVARIATE ANALYSIS; Patient Selection; PLANNING; Platelet Count; Prospective Studies; RADIOLOGY AND NUCLEAR MEDICINE; REGRESSION ANALYSIS; Retrospective Studies; Severity of Illness Index; Shock, Hemorrhagic - blood; Shock, Hemorrhagic - diagnostic imaging; Shock, Hemorrhagic - etiology; Shock, Hemorrhagic - physiopathology; Shock, Hemorrhagic - therapy; Treatment Outcome
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-007-9131-5

We applied multivariate analysis to the clinical findings in patients with acute gastrointestinal (GI) hemorrhage and compared the relationship between these findings and angiographic evidence of extravasation. Our study population consisted of 46 patients with acute GI bleeding. They were divided into two groups. In group 1 we retrospectively analyzed 41 angiograms obtained in 29 patients (age range, 25-91 years; average, 71 years). Their clinical findings including the shock index (SI), diastolic blood pressure, hemoglobin, platelet counts, and age, which were quantitatively analyzed. In group 2, consisting of 17 patients (age range, 21-78 years; average, 60 years), we prospectively applied statistical analysis by a logistics regression model to their clinical findings and then assessed 21 angiograms obtained in these patients to determine whether our model was useful for predicting the presence of angiographic evidence of extravasation. On 18 of 41 (43.9%) angiograms in group 1 there was evidence of extravasation; in 3 patients it was demonstrated only by selective angiography. Factors significantly associated with angiographic visualization of extravasation were the SI and patient age. For differentiation between cases with and cases without angiographic evidence of extravasation, the maximum cutoff point was between 0.51 and 0.0.53. Of the 21 angiograms obtained in group 2, 13 (61.9%) showed evidence of extravasation; in 1 patient it was demonstrated only on selective angiograms. We found that in 90% of the cases, the prospective application of our model correctly predicted the angiographically confirmed presence or absence of extravasation. We conclude that in patients with GI hemorrhage, angiographic visualization of extravasation is associated with the pre-embolization SI. Patients with a high SI value should undergo study to facilitate optimal treatment planning.