Clinical characteristics and outcomes of splenic infarction in cancer patients: a retrospective, single center report of 206 cases

Risk factors for mortality among patients with splenic infarction in the emergency department

BACKGROUND

Splenic infarction is relatively uncommon with a mortality rate ranging from 5% to 34% reported in the literature. Research that focuses on this disease, particularly regarding its mortality risk factors, is scarce. This study aimed to identify the characteristics of splenic infarction and investigate risk factors for 30-day mortality in patients diagnosed with this disease in an emergency department (ED).

METHODS

This retrospective cohort study utilized a computed tomography (CT) database search to identify adult patients who received their first diagnosis of splenic infarction via CT scan during ED visits at a Taiwanese medical center from January 2011 to December 2021. The study employed logistic regression analysis to identify prognostic factors for 30-day mortality.

RESULTS

The study involved 73 patients with a median age of 71 years. ICU admission was required for 23.3% of patients, and the average hospital stay was 14 days. The 30-day mortality rate was 23.3%. Univariate logistic regression analysis revealed several mortality risk factors, including low hemoglobin level, diabetes mellitus, uremia requiring renal replacement therapy, active malignancy, high Taiwan Triage and Acuity Scale (TTAS) level, increased qSOFA score, along with high MEWS. Multivariate logistic regression analysis identified uremia requiring renal replacement therapy, active malignancy, and high TTAS level as independent predictors.

CONCLUSION

For ED patients with splenic infarction, the 30-day mortality rate was 23.3%. Independent predictors of mortality included uremia requiring renal replacement therapy, active malignancy, and high triage levels.

Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study

Background: Patients with splenic infarction (SI) are associated with a prothrombotic state and are vulnerable to subsequent thromboembolic complications. However, due to its rarity, there is no established treatment modality in this population. We aimed to examine the effect of anticoagulant therapy in SI patients.

Methods: We performed a multicenter retrospective cohort study of 86 SI patients. Patients were categorized as anticoagulant users and anticoagulant non-users. The associations between anticoagulant therapy, all-cause mortality, thromboembolic events and bleeding events were evaluated.

Results: Forty-five patients (52.3%) received anticoagulant therapy during the follow-up periods. The all-cause mortality rate was 6.86 per 100 patient-years. Anticoagulant therapy was associated with 94% improved survival (HR = 0.06; Cl 0.007–0.48; p = 0.008), while the risk factors for all-cause mortality were prior stroke (HR = 13.15; Cl 2.39–72.27; p = 0.003) and liver cirrhosis (HR = 8.71; Cl 1.29–59.01; p = 0.027). Patients with anticoagulant therapy had a higher event-free survival curve for thromboembolic complications (p = 0.03) but did not achieve a significant difference after adjustment using the Cox regression model as a time-dependent covariate (HR = 0.57; Cl 0.13–2.45; p = 0.446). There was no significant difference in the risk of bleeding events between the groups (p = 0.728).

Conclusions: Anticoagulant therapy in patients with SI was associated with better survival and was not related to an increased bleeding risk.