Risk factors for 30-day mortality in patients with head and neck cancer bleeding in the emergency department

• Published in: The American journal of emergency medicine Vol. 58; pp. 9 - 15
• Main Authors: Yen, Chieh-Ching, Yeh, Heng, Ho, Che-Fang, Hsiao, Chien-Han, Niu, Kuang-Yu, Yeh, Chung-Cheng, Lu, Jian-Xun, Wu, Chia-Chien, Chang, Yun-Chen, Ng, Chip-Jin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2022; Elsevier Limited
• Subjects: Bleeding; Blood transfusion; Cancer therapies; Emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Head & neck cancer; Head and neck cancer; Head and Neck Neoplasms - complications; Health risks; Heart rate; Hemorrhage; Hemorrhage - etiology; Humans; Medical imaging; Mortality; Oral cavity; Patients; Proportional Hazards Models; Risk Factors; Statistical analysis; Survival; Taiwan; Head and neck cancer; Emergency department; Hemorrhage; Mortality; Bleeding
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2022.05.008

Acute head and neck cancer (HNC) bleeding is a life-threatening situation that frequently presents to the emergency department (ED). The purpose of the present study was to analyze the risk factors for the 30-day mortality in patients with HNC bleeding. We included patients who presented to the ED with HNC bleeding (n = 241). Patients were divided into the survivor and nonsurvivor groups. Variables were compared, and the associated factors were examined with Cox's proportional hazard model. Of the 241 patients enrolled, the most common bleeding site was the oral cavity (n = 101, 41.9%). More than half of the patients had advanced HNC stage while 41.5% had local recurrence. The proportion of active bleeding was significantly higher in the nonsurvivor group (70.5% vs. 53.3%, p = 0.038). 42.3% received blood transfusion and 5.0% required inotropic support. In total, 21.2% of the patients experienced rebleeding, and 18.3% died within 30 days. Multivariate analyses indicated that a heart rate > 100 (beats/min) (HR = 2.42; Cl 1.15–5.06; p = 0.019) and inotropic support (HR = 3.00; Cl 1.14–7.89; p = 0.026) were statistically significant independent risk factors for 30-day mortality. The results of this study may aid physicians in the evaluation of short-term survival in HNC bleeding patients and provide critical information for risk stratification and medical decisions.