ArticleCardiovascular and interventional radiology2026
Computed Tomography-Proven Active Bleeding with Negative Emergency Angiography: Early Mortality Predictors and Development of the Negative Angiography Bleeding-Lethality Score.
Article in Cardiovascular and interventional radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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
methodsWe 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.
resultsA 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).
conclusionCT-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.
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