Splenic contraction: a new member of the hypovolemic shock complex

Enslow, Michael S.; Preece, Stephen R.; Wildman-Tobriner, Benjamin; Enslow, Ryan A; Mazurowski, Maciej A.; Nelson, Rendon C.

doi:10.1007/s00261-018-1478-3

Cited by 27 publications

(15 citation statements)

References 29 publications

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“…Enslow et al reported that 71 trauma patients had significantly smaller spleens than healthy controls (107 AE 63 cm 3 vs. 220 AE 164 cm 3 ). In addition, 34 of 35 patients had a 30% greater reduction in spleen volume when in shock than in pre-shock (Enslow et al, 2018). There are two mechanisms by which organ size is reduced during hemorrhagic shock.…”

Section: Discussionmentioning

confidence: 98%

Splenic volume on computed tomography scans is associated with mortality in patients with sepsis

Mitsuyama

Shimizu

Hirayama

et al. 2021

International Journal of Infectious Diseases

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The spleen is a key organ of the immune system. Asplenia has been reported to increase the risk of sepsis from overwhelming post-splenectomy infection. However, there are few reports on the association between splenic volume and mortality in patients with no history of splenectomy. This study focused on splenic volume of patients with sepsis and evaluated the association between splenic volume and mortality. Methods: We retrospectively investigated 232 patients with sepsis. The splenic volume was calculated by using computed tomography scans obtained on admission. The patients were categorized into tertiles based on their splenic volume, and the relationship between splenic volume and mortality was evaluated. Odds ratio curves based on splenic volume were created to assess the continuous associations between splenic volume and outcome with a logistic regression model. Results: The patients with sepsis were divided into three groups according to the first (73.6 cm 3 ) and second (128.7 cm 3 ) tertile values of splenic volume. Kaplan-Meier estimation of the probability of the patients' survival followed up to 28 days showed significant differences between the groups (p= 0.03). The hazard ratio for 28-day mortality in the first tertile group was 3.46 (95% CI 1.3-10.2; p = 0.01) as compared with patients in the third tertile group. Patients with smaller spleens had increased odds ratios for mortality in the logistic regression model. Conclusions: Splenic volume appeared to be an independent predictor of poor prognosis.

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Section: Discussionmentioning

confidence: 98%

Splenic volume on computed tomography scans is associated with mortality in patients with sepsis

Mitsuyama

Shimizu

Hirayama

et al. 2021

International Journal of Infectious Diseases

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“…It also interacts with the kidneys and mesenteric vascular bed via nervous and hormonal regulation, 8 and contracts in response to adrenergic stimulation in a state of sympathetic nerve hyperactivity, such as during hypovolemic shock or hemorrhagic shock. 9,10…”

Section: Discussionmentioning

confidence: 99%

Association between splenic volume and pulsatility index in patients with left ventricular assist devices

et al. 2020

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The spleen serves as a blood volume reservoir for systemic volume regulation in heart failure (HF) patients. Changes are seen in spleen size in advanced HF patients after left ventricular assist device (LVAD) implantation. The pulsatility index (PI) is an indicator of native heart contractility with hemodynamic changes in patients using LVAD. We hypothesized that the splenic volume was associated with the PI, reflecting the hemodynamics in advanced HF patients with LVADs. Herein, we investigated the relationship between splenic volume and PI in these patients. Forty-four patients with advanced HF underwent implantation of HeartMate II® (Abbott, Chicago, IL, USA) as a bridge to heart transplantation at the Nagoya University Hospital between October 2013 and June 2019. The data of 27 patients (21 men, median age 46 years) were analyzed retrospectively. All patients underwent blood tests, echocardiography, right heart catheterization, and computed tomography (CT). Spleen size was measured via CT volumetry; the splenic volume (median: 190 mL) correlated with right arterial pressure ( r = 0.431, p = 0.025) and pulmonary capillary wedge pressure ( r = 0.384, p = 0.048). On multivariate linear regression analysis, the heart rate (β = −0.452, p = 0.003), pump power (β = −0.325, p = 0.023), and splenic volume (β = 0.299, p = 0.038) were independent determinants of PI. The splenic volume was associated with PI, reflecting the cardiac preload in advanced HF patients with LVADs. Thus, spleen measurement using CT may help estimate the systemic volume status and understand the hemodynamic conditions in LVAD patients.

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“…In the event of a circulatory shock, the spleen fulfills its reservoir function by reducing the arterial inflow and increasing the venous outflow [1]. In this context, Enslow et al demonstrated a decrease in volume and an associated reduction of the spleen's density values [15]. Moreover, a decreased splenic enhancement in the arterial phase may be a mortality predictor in patients with hypovolemic shock [14].…”

Section: Discussionmentioning

confidence: 99%

“…The adrenal-to-IVC ratio was defined by the mean radiodensities of adrenal glands divided by the IVC's radiodensity. The splenic attenuation value was obtained by placing three circular ROIs (2.0 cm 2 in size) at three different axial levels through the superior third, middle third, and inferior third of the spleen in portal venous phase [15]. Hypodense triangular wedge-shaped areas at the periphery of the spleen were not included in the measurement.…”

Section: Image Analysismentioning

confidence: 99%

Bilateral adrenal enhancement revised—adrenal-to-spleen ratio as an appropriate mortality predictor

Winzer¹,

Martin²,

Kaiser³

et al. 2020

Abdom Radiol

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Purpose To investigate whether adrenal gland radiodensities alone or set in relation to either the inferior vena cava (IVC) or the spleen can predict hospital mortality in intensive care unit patients. Methods One hundred thirty-three intensive care patients (90 males, age: 66.3 ± 14.5 years) with an acute clinical deterioration were included in this retrospective analysis. CT attenuation (Hounsfield units) of adrenal glands, IVC, and spleen was evaluated by 2 radiologists separately. Adrenal-to-IVC and adrenal-to-spleen ratios were calculated. Receiver operating characteristic (ROC) analysis, combined with the Matthews correlation coefficient (MCC) as a classifier, was used to assess which parameter is the most suitable for short-term, intermediate-term, and overall mortality prediction. Interrater agreement was assessed using intraclass correlation coefficient (ICC). Results The highest discriminative power to distinguish between deceased and survivors was found for the adrenal gland-to-spleen ratio for the 72-h mortality. A threshold of > 1.4 predicted 72-h mortality with a sensitivity of 79.31% and a specificity of 98.08% (area und the curve (AUC) = 0.94; p < 0.0001; MCCs = 0.81). The positive likelihood ratio was 41; the positive predictive value was 92.20%. Adrenal gland-to-spleen ratio was also best suited to predict the 24-h and overall mortality. ICCs of HU measurements in adrenal gland, IVC, and spleen indicated a high interrater agreement (ICC 0.95–0.99). Conclusions To conclude, the adrenal-to-spleen ratio in CT in portal venous phase may serve as an imaged-based predictor for short, intermediate, and overall mortality and as reproducible prognostic marker for patient outcome.

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Splenic contraction: a new member of the hypovolemic shock complex

Cited by 27 publications

References 29 publications

Splenic volume on computed tomography scans is associated with mortality in patients with sepsis

Splenic volume on computed tomography scans is associated with mortality in patients with sepsis

Association between splenic volume and pulsatility index in patients with left ventricular assist devices

Bilateral adrenal enhancement revised—adrenal-to-spleen ratio as an appropriate mortality predictor

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