Risk assessment and prognostic analysis of patients with splenic infarction in emergency department: a multicenter retrospective study

Abstract

Splenic infarction is a thromboembolic disease that is frequently missed in acute settings. Previous reviews were rarely presented from a clinical perspective. We aimed to evaluate the clinical characteristics, risk factors with diagnostic value, and prognostic factors using large cohort data and a matched case–control study method. A retrospective medical record review of six hospitals in Taiwan from January 1, 2005, to August 31, 2020, was conducted. All patients who underwent contrast CT with confirmed the diagnosis of splenic infarction were included. Their characteristics were presented and compared to a matched control group with similar presenting characteristics. Prognostic factors were also analyzed. A total of 130 cases were included, two-thirds of whom presented with abdominal pain. Atrial fibrillation was the most common associated predisposing condition, followed by hematologic disease. A higher proportion of tachycardia, positive qSOFA score, history of hypertension or atrial fibrillation, leukocytosis, and thrombocytopenia were found in splenic infarction patients compared to their counterparts. An underlying etiology of infective endocarditis was associated with a higher proportion of ICU admission. Splenic infarction patients often presented with left upper abdominal pain and tachycardia. A history of hypertension, atrial fibrillation, a laboratory result of leukocytosis or thrombocytopenia may provide a clue for clinicians to include splenic infarction in the differential list. Among the patients diagnosed with splenic infarction, those with an underlying etiology of infectious endocarditis may be prone to deterioration or ICU admission.

Isolated Splenic Infarction: An Initial Manifestation of Postoperative Atrial Fibrillation

“…In about 10-33% of cases, no abdominal pain was reported in patients with SI. 1 - 4 Being an uncommon event with a variable clinical presentation, SI is under-diagnosed. 4 …”

“… 7 Once the diagnosis of SI is established, investigating the underlying etiology is important as it helps in managing the patient and establishing the prognosis. 2 Moreover, SI could be the initial presentation in patients with underlying medical conditions, which would be diagnosed later. In a study by Lawrence et al, 21 out of 26 patients had initial presentation with SI and were subsequently diagnosed with medical conditions, like our case report.…”

“…As the patient was hemodynamically stable, no surgical intervention was recommended. As cardio-embolic source is the major source of S I, 1 - 4 alone or associated with other conditions, we empirically started the patient on enoxaparin while she was being worked up. The patient’s elevated creatinine was pre-renal in etiology (secondary to decreased intake and high ileostomy output).…”

“…Despite being an uncommon phenomenon, the clinical burden on the patient population is significant with a mortality rate of 11% to 20%. 1 , 2 The etiology of SI could be multifactorial; moreover, recent studies have shown an increase in newly diagnosed disease in patients being admitted with SI as the initial presentation. 3 Splenic infarcts have been associated with many conditions and have been reported as postoperative complications, in association with thrombophilic syndromes, inflammatory bowel disease, myeloproliferative disorders, phospholipid syndrome, cardiac arrhythmia such as atrial fibrillation, and arteriosclerotic arterial disease.…”

Case Report: Acute Renal and Splenic Infarctions Secondary to Atrial Fibrillation

“…It is generally agreed upon that the causes of acute renal infarction are renal artery lesions, atrial fibrillation (AF), valvular or ischemic heart disease, peripheral vascular disease, and hypercoagulable state, among which AF seems to be the leading cause, but its frequency differs among studies ( 5 , 6 ). AF is also the most common associated predisposing condition in SI ( 7 ). Virchow's triad at the AF state produces imbalances between thrombotic and thrombolytic factors, leading to the formation of embolus, which may dislodge and travel through the systemic circulation, finally resulting in embolism in the end organs ( 8 ).…”