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Purpose <p>To identify predictors of 30-day mortality and derive a bedside risk score in patients with computed tomography (CT)-proven active bleeding and negative emergency angiography.</p> Materials and Methods <p>We retrospectively included consecutive adults with CT-detected active bleeding and negative emergency angiography in a single-center cohort (2012–2026). Univariate analyses (Fisher exact, Mann–Whitney U) were followed by multivariable logistic regression, with a LASSO-penalized model (fivefold cross-validation) performed as sensitivity analysis. A simplified score, Negative Angiography Bleeding–Lethality (NAB-L), was derived from regression coefficients. Discrimination was assessed by area under the receiver operating characteristic curve (AUC) with bootstrap internal validation, calibration by the Hosmer–Lemeshow test, and survival by Kaplan–Meier methods with log-rank comparison.</p> Results <p>A total of 118 patients were included (median age 67.5&#xa0;years [IQR 51–78]; 55% male). Thirty-day mortality was 14.4% (17/118) and rebleeding occurred in 33.9% (40/118). Hemoglobin nadir &lt; 8&#xa0;g/dL (adjusted odds ratio (aOR) 11.44; 95% confidence intervals (CI) 1.45–90.35), arterial lactate &gt; 2&#xa0;mmol/L (aOR 5.69; 1.27–25.42), and age &gt; 70&#xa0;years (aOR 3.63; 1.01–13.02) were independently associated with mortality. The NAB-L score (0–5) showed good discrimination (AUC 0.854; 95% CI 0.760–0.941; optimism-corrected 0.816) and adequate calibration (Hosmer–Lemeshow <i>p</i> = 0.946). Mortality rose from 0% (score 0–1) to 56% (score 5). Rebleeding was more frequent in high-risk patients (52% vs. 17%, <i>p</i> = 0.036).</p> Conclusion <p>CT-positive/angiography-negative bleeding carries substantial early mortality and rebleeding risk. The NAB-L score enables simple early bedside risk stratification but should be considered hypothesis-generating pending external validation.</p> Graphical Abstract <p></p>

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Computed Tomography-Proven Active Bleeding with Negative Emergency Angiography: Early Mortality Predictors and Development of the Negative Angiography Bleeding-Lethality Score

  • 期刊论文

  • 发表日期：

    2026年8月2日

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  • Louis Russier,
  • Ilies El Boukili,
  • Nory Elhadjene,
  • Nicolas Magand,
  • Noémie Lutz,
  • Claire Boutet,
  • Sylvain Grange,
  • Rémi Grange

摘要

Purpose

To identify predictors of 30-day mortality and derive a bedside risk score in patients with computed tomography (CT)-proven active bleeding and negative emergency angiography.

Materials and Methods

We retrospectively included consecutive adults with CT-detected active bleeding and negative emergency angiography in a single-center cohort (2012–2026). Univariate analyses (Fisher exact, Mann–Whitney U) were followed by multivariable logistic regression, with a LASSO-penalized model (fivefold cross-validation) performed as sensitivity analysis. A simplified score, Negative Angiography Bleeding–Lethality (NAB-L), was derived from regression coefficients. Discrimination was assessed by area under the receiver operating characteristic curve (AUC) with bootstrap internal validation, calibration by the Hosmer–Lemeshow test, and survival by Kaplan–Meier methods with log-rank comparison.

Results

A total of 118 patients were included (median age 67.5 years [IQR 51–78]; 55% male). Thirty-day mortality was 14.4% (17/118) and rebleeding occurred in 33.9% (40/118). Hemoglobin nadir < 8 g/dL (adjusted odds ratio (aOR) 11.44; 95% confidence intervals (CI) 1.45–90.35), arterial lactate > 2 mmol/L (aOR 5.69; 1.27–25.42), and age > 70 years (aOR 3.63; 1.01–13.02) were independently associated with mortality. The NAB-L score (0–5) showed good discrimination (AUC 0.854; 95% CI 0.760–0.941; optimism-corrected 0.816) and adequate calibration (Hosmer–Lemeshow p = 0.946). Mortality rose from 0% (score 0–1) to 56% (score 5). Rebleeding was more frequent in high-risk patients (52% vs. 17%, p = 0.036).

Conclusion

CT-positive/angiography-negative bleeding carries substantial early mortality and rebleeding risk. The NAB-L score enables simple early bedside risk stratification but should be considered hypothesis-generating pending external validation.

Graphical Abstract