Rapid, moderate, or slow bleeding? CT analysis of abdominopelvic active vascular contrast extravasation classes and mortality outcomes

Abstract

Objectives: Building on prior findings that active vascular contrast extravasation (AVCE) size is an independent predictor of in-hospital mortality in abdominopelvic hemorrhages, this study aimed to categorize AVCEs using latent profile analysis (LPA) and examine differences in patient characteristics, treatments, and outcomes. Methods: We retrospectively included consecutive adults with CT-detected AVCE between January 2019 and May 2022. LPA was applied to classify AVCEs based on size-related features, optimizing the number of classes predictive of 24-h and in-hospital mortality. These classes were compared using univariable analysis with post-hoc pairwise comparisons to identify significant differences. Cutoff values for categorization were derived from size parameters and changes across arterial (AP) and portovenous (PVP) phases. Results: LPA classified 223 patients with single-organ, traumatic, and nontraumatic AVCEs (mean age 59.8 ± 20.1 years, 123 men) into three groups-slow (n = 136), moderate (n = 75), and rapid (n = 12). Slow AVCEs showed smaller size parameters and minimal changes between AP and delayed phases. Rapid AVCEs frequently exhibited coexisting pseudoaneurysms, smaller areas on AP, lower mean attenuation differences in AP-PVP pairs, and were associated with lower systolic and diastolic blood pressures, requiring the highest quantity of packed red cells. Perimeter percentage changes between AP and PVP performed comparably to LPA classes and provided practical classification cutoffs. Conclusion: LPA-based classification of AVCEs into slow, moderate, and rapid types revealed distinct size patterns and associated clinical outcomes, offering a robust framework for risk stratification and guiding management of abdominopelvic hemorrhages. Key Points: Question It is unclear if the size of active vascular contrast extravasation (AVCE) is predictive of mortality in patients with abdominopelvic hemorrhage. Findings AVCEs could be classified by latent profile analysis into three groups: slow, moderate, and rapid, based on size at multiphasic CT with distinct mortality risks. Clinical relevance Practical cutoff values of perimeter percentage changes of AVCE between arterial- and portovenous-phase CT were identified for AVCE classification, potentially guiding clinical prioritization and management of patients with abdominopelvic hemorrhage.