Spontaneous rectus sheath hematoma: Beyond hematoma size, volume, and treatment method – The dominant influence of comorbidity on prognosis and mortality: A single-center retrospective study
Medicine (United States), cilt.105, sa.6, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 105 Sayı: 6
- Basım Tarihi: 2026
- Doi Numarası: 10.1097/md.0000000000047583
- Dergi Adı: Medicine (United States)
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE, Directory of Open Access Journals
- Anahtar Kelimeler: Charlson comorbidity index, conservative management, embolization of epigastric arteries, mortality rate, spontaneous rectus sheath hematoma
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Spontaneous rectus sheath hematoma (RSH) is a rare but potentially life-threatening cause of acute abdominal pain. Prognosis has traditionally been assessed by hematoma size or imaging features, but the influence of systemic comorbidity is poorly defined. This study investigates the predictive value of the Charlson comorbidity index (CCI) on mortality and treatment outcomes in patients with RSH. We retrospectively analyzed 44 adult patients (≥18 years) diagnosed with spontaneous RSH at Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey, between January 2020 and December 2024. Patients with traumatic or postsurgical hematomas were excluded. Hematoma size and volume were measured via computed tomography imaging. Demographics, comorbidities, laboratory parameters, and treatment modalities (conservative, interventional embolization, surgical) were recorded. The primary endpoint was in-hospital mortality. Receiver operating characteristic curve and logistic regression analyses were performed to evaluate the predictive performance of CCI. Systemic comorbidity, as quantified by CCI, is a stronger predictor of mortality and treatment outcomes in RSH than hematoma size or imaging characteristics. Integration of comorbidity assessment into clinical decision-making is recommended for early risk stratification and personalized management. Prospective multicenter studies are warranted to validate these findings and establish comprehensive management algorithms. The mean patient age was 61.5 ± 15.3 years; the mean hematoma volume was 512.9 ± 462.7 mm3, and the mean CCI score was 4.84 ± 2.54. Overall survival was 77.3% (n = 34), while 22.7% (n = 10) of patients died. Mortality was not significantly associated with hematoma volume, laboratory parameters, or treatment modality. In contrast, non-survivors had significantly higher CCI scores (6.60 ± 3.24 vs 4.30 ± 2.11; P = .011). Multivariate analysis confirmed CCI as an independent predictor of in-hospital mortality (odds ratio = 1.46 per point increase; P = .022). Receiver operating characteristic analysis demonstrated moderate discriminatory power (area under the curve = 0.732), with a threshold of CCI ≥ 6 optimally predicting mortality. Decision curve analysis showed modest clinical benefit for early risk stratification using CCI.