title: Predisposing factors, management, and prognostic evaluation of acute carotid blowout syndrome.
abstract: BACKGROUND
  Massive hemorrhages occur in 6%-10% of patients with advanced cancer. Acute carotid blowout syndrome is the most severe massive hemorrhagic complication in head and neck cancer patients.
  
  
  METHODS
  This was a single institute, retrospective, case control study. A total of 45 patients were enrolled in this study. The predisposing factors, management, and prognosis of acute carotid blowout syndrome were evaluated.
  
  
  RESULTS
  Among the baseline characteristics, the site of the primary tumor (P = .003), origin of bleeding (P = .048), method of intervention (P = .005), and time to intervention (P = .006) were significantly different factors between survivor and nonsurvivor patients. After 24 hours of onset, a Glasgow Coma Scale score (P = .000), the use of inotropic agents (P = .007), and neutrophil-to-lymphocyte ratio (P = .019) were significantly predicting factors for outcome. Multivariate logistic regression analyses revealed bleeding from common carotid artery was an independent factor for long-term survival (odds ratio, 25.951; 95% confidence interval [CI], 1.373-490.441; P < .030). The median overall survival of survivors and nonsurvivors were 12.1 (range, 3.7-118.7; 95% CI, 4.33-54.87) and 11.9 (range, 0.7-53.5; 95% CI, 5.78-25.69) months, respectively (P = .092).
  
  
  CONCLUSIONS
  Early and aggressive intervention is important for the successful management of acute carotid blowout syndrome. The Glasgow Coma Scale score, the use of inotropic agents, and neutrophil-to-lymphocyte ratio 24 hours after the onset were predictive factors for patients' outcomes. Bleeding from common carotid artery is an independent prognostic factor in multivariate analysis. Long-term survival can be achieved after successful management.
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors: Hsueh-Ju
authors: HJ
authors: Lu
authors: Kuo-Wei
authors: KW
authors: Chen
authors: Ming-Huang
authors: MH
authors: Chen
authors: Pen-Yuan
authors: PY
authors: Chu
authors: Shyh-Kuan
authors: SK
authors: Tai
authors: Ling-Wei
authors: LW
authors: Wang
authors: Peter Mu-Hsin
authors: PM
authors: Chang
authors: Muh-Hwa
authors: MH
authors: Yang
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D015600:Glasgow Coma Scale; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000401:mortality; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013577:Syndrome; D013624:Taiwan; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents