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CT signs of hypovolemic shock complex in patients with non-traumatic shock

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Abstract

Purpose

To assess the frequency of hypovolemic shock complex (HSC) signs on CT in patients who presented to the emergency department (ED) with undifferentiated non-traumatic shock. Secondary aim was to assess the correlation between HSC signs and all-cause mortality.

Methods

This retrospective, single-center study included 100 patients who underwent contrast-enhanced thoraco-abdominal CT in the ED to evaluate the etiology for non-traumatic undifferentiated shock. All patients were retrospectively assigned a shock subtype (i.e., distributive, cardiogenic, hypovolemic, obstructive, multifactorial, and unknown) based on medical records. Patients’ demographics and time to all-cause mortality up to 90 days were collected. All CT studies were re-assessed for the presence of HSC signs. Correlation between HSC signs, mortality and shock subtype was assessed.

Results

Overall, 58% (58/100) of all patients had at least one HSC sign. Flattened inferior vena cava and adrenal hyper-enhancement were the most common HSC signs (27.3%, 27/99; in both). Overall mortality was 59% (59/100). When evaluated separately, shock liver was the only HSC sign to significantly correlate with increased mortality (84.6% vs. 55.2%, p = .04). However, patients with at least two HSC signs had a significantly higher mortality rate compared to patients without any HSC signs (73.5% vs. 45.2%, p = .017).

Conclusion

Most patients with non-traumatic shock had at least one HSC sign. Mortality rates were significantly higher in patients with two or more HSC signs compared to patients without any signs. Patients with shock liver sign had significantly higher mortality rates.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel

    Israel Cohen, Noam Tau, Matan Kraus & Larisa Guranda

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Israel Cohen, Noam Tau, Ruth Lekach, Avinoah Ironi, Matan Kraus & Larisa Guranda

  3. Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel

    Avinoah Ironi

Authors
  1. Israel Cohen
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  2. Noam Tau
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  4. Avinoah Ironi
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Correspondence to Israel Cohen.

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Cohen, I., Tau, N., Lekach, R. et al. CT signs of hypovolemic shock complex in patients with non-traumatic shock. Abdom Radiol 48, 229–235 (2023). https://doi.org/10.1007/s00261-022-03698-9

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  • DOI: https://doi.org/10.1007/s00261-022-03698-9

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