Factors Associated with Survival to Discharge in Cats with Spontaneous Hemoperitoneum

This study aims to describe the clinical presentation, treatment and outcomes of cats diagnosed with spontaneous hemoperitoneum and to identify factors associated with survival to discharge. Medical records from 2005 to 2024 were searched and data was reviewed retrospectively. Clinical, diagnostic and treatment variables were evaluated for their association with survival to discharge. Seventy-three cats were included. The most common presenting clinical signs at diagnosis were lethargy, hyporexia and collapse. Hemoperitoneum was most often originating from the liver (41 cats), the spleen (19 cats) and pancreas (three cats), with forty-two cats requiring transfusion of blood products. Twenty-two cats (30%) underwent surgery while 21 cats (29%) were managed conservatively, and 30 (41%) cats were euthanized at presentation or diagnosis. Neoplasia was the most common diagnosis (50 cats, 68.5%) with hemangiosarcoma being most common. The most common non-neoplastic conditions included amyloidosis (eight cats) and hepatic vacuolar hepatopathy (three cats). Overall survival to discharge was 38%. Surgery was the only variable associated with survival to discharge (p = 0.031). Cats receiving transfusions were more likely to survive (p = 0.013). Survival did not differ between cats with and without neoplasia (p = 0.366) or by bleeding origin (liver vs. spleen; p = 0.483). Survival to discharge for cats with spontaneous hemoperitoneum remains guarded. Hepatic and splenic neoplasia were the most common diagnoses, with hemangiosarcoma representing the most common primary neoplasia. Cats undergoing surgery, regardless of final diagnosis, and those receiving blood products had the highest likelihood of survival to discharge.