# The utility of computed tomography-derived inferior vena cava parameters in predicting outcomes in patients with active bleeding undergoing transarterial embolization

## TL;DR

This study explores how CT scan measurements of the inferior vena cava can predict outcomes in patients with active bleeding undergoing a specific treatment.

## Contribution

The study introduces the use of CT-derived IVC parameters to predict mortality in patients with active bleeding.

## Key findings

- A higher IVC flatness index was associated with increased 30-day mortality.
- IVC volume did not differ significantly between survivors and nonsurvivors.
- The IVC flatness index showed a statistically significant association with mortality in multivariable analysis.

## Abstract

The inferior vena cava (IVC) parameters are associated with prognostic significance in emergency patients, but there is a lack of data using this parameter in patients with active bleeding.

To investigate the prognostic relevance of IVC parameters in patients with active bleeding.

A retrospective analysis was conducted on consecutive patients who underwent transarterial embolization due to bleeding from different anatomical sites following computed tomography (CT) imaging at a university medical center over a five-year period (2018–2022). The initial CT scan was used to determine the IVC volume and IVC flatness index, which were then incorporated into multivariable regression analyses that included demographic, hemodynamic, and laboratory data.

The analysis included 188 patients (75.3% male) with a median age of 50 years, and a massive transfusion rate and an all-cause 30-day mortality rate of 26.6% each. Compared with female patients, male patients had a significantly higher median IVC volume (25.45 vs. 15.8 cm³, p < 0.001), whereas the median IVC flatness index was similar for both sexes (14 vs. 14, p = 0.414). Median IVC volumes were similar between 30-day survivors and nonsurvivors (21.6 vs. 20.2 cm³, p = 0.382) and between patients who underwent massive transfusion and those who did not (21.2 vs. 21.5 cm³, p = 0.567). A multivariable Cox proportional hazards model revealed a statistically significant association between the IVC flatness index and 30-day mortality (hazard ratio, 1.27; 95% confidence interval, 1.01–1.59; p = 0.038). Additionally, logistic regression analysis revealed no significant association between the IVC flatness index and massive transfusion (univariable odds ratio, 1.01; 95% confidence interval, 0.75–1.34; p = 0.972).

A higher IVC flatness index was associated with 30-day mortality in patients undergoing transarterial embolization for active bleeding. Further studies are needed to determine the prognostic value of CT-derived IVC parameters.

The online version contains supplementary material available at 10.1186/s12245-025-01033-9.