Predictors of Acute Transmural Intestinal Necrosis in Acute Mesenteric Ischemia: A Single-Center Retrospective Study

Background: Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes.Methods: A monocentric retrospective study was conducted between 01 August 2013 and 31 December 2019; 24 AMI patients underwent surgery (17 men and 7 women). Retrospectively, the risk factors, management until diagnosis and mortality were evaluated.Results: Patients present with an acute pain of the abdomen. Diagnosis was provided by CT with contrast medium. The 30-day mortality was 45.8%, the late mortality was 25% and the overall mortality was 70.8%. For the <12 hours delay group, the mortality was 33.3%, and the mortality in the group with 12-24 hours delay was 80% and was 87.5% in the >24 hours after admission group.Conclusions: If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.21% of all acute surgical admissions.

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A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia: a retrospective study

BMC Gastroenterology ◽

10.1186/s12876-021-01746-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinsuo Zhuang ◽

Fumei Chen ◽

Qian Zhou ◽

Yuanrun Zhu ◽

Xiaofeng Yang

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Prediction Model ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Univariate Analysis ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Wbc Count ◽

Early Surgical Intervention

Abstract Background Acute mesenteric ischemia (AMI) is a life-threatening condition. However, there is no accurate method to predict intestinal necrosis in AMI patients that may facilitate early surgical intervention. This study thus aimed to explore a simple and accurate model to predict intestinal necrosis in patients with AMI. Methods A single-center retrospective study was performed on the data of 132 AMI patients treated between October 2011 and June 2020. The patients were divided into the intestinal necrosis and non-intestinal necrosis groups. The clinical characteristics and laboratory data were analyzed by univariate analysis, and the variables with statistical significance were further analyzed by multivariate logistic regression analysis. The independent predictors of intestinal necrosis were determined and a logistic prediction model was established. Finally, the accuracy, sensitivity, and specificity of the model in predicting intestinal necrosis were evaluated. Results Univariate analysis showed that white blood cell (WBC) count, blood urea nitrogen (BUN) level, neutrophil ratio, prothrombin time (PT), and LnD-dimer were associated with intestinal necrosis. According to logistic regression multivariate analysis, WBC count, BUN level and LnD-dimer were independent predictors of intestinal necrosis. These parameters were used to establish a clinical prediction model of intestinal necrosis (CPMIN) as follows: model score = 0.349 × BUN (mmol/L) + 0.109 × WBC × 109 (109/L) + 0.394 × LnD − Dimer (ug/L) − 7.883. The area under the receiver operating characteristics (ROC) curve of the model was 0.889 (95% confidence interval: 0.833–0.944). Model scores greater than − 0.1992 predicted the onset of intestinal necrosis. The accuracy, specificity, and sensitivity of the model were 82.6%, 78.2%, and 88.3%, respectively. The proportion of intestinal necrosis in the high-risk patient group (CPMIN score ≥ − 0.1992) was much greater than that in the low-risk patient group (CPMIN score < − 0.1992; 82.7% vs. 15.0%, p < 0.001). Conclusion The CPMIN can effectively predict intestinal necrosis and guide early surgical intervention to improve patient prognosis. Patients with AMI who are classified as high-risk should be promptly treated with surgery to avoid the potential complications caused by delayed operation. Patients classified as low-risk group can receive non-surgical treatment. This model may help to lower the morbidity and mortality from AMI. However, this model’s accuracy should be validated by larger sample size studies in the future.

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A Rapid Prediction Model for Intestinal Necrosis in Acute Mesenteric Ischemia: A Retrospective Study

10.21203/rs.3.rs-152495/v1 ◽

2021 ◽

Author(s):

Xinsuo Zhuang ◽

Fumei Chen ◽

Qian Zhou ◽

Yuanrun Zhu ◽

Xiaofeng Yang

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Prediction Model ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Univariate Analysis ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Wbc Count ◽

Early Surgical Intervention

Abstract Background：Acute mesenteric ischemia (AMI) is a life-threatening condition. However, there is no accurate method to predict intestinal necrosis in AMI patients that may facilitate early surgical intervention. This study thus aimed to explore a simple and accurate model to predict intestinal necrosis in patients with AMI.Methods: A single-center retrospective study was performed on the data of 132 AMI patients treated between October 2011 and June 2020. The patients were divided into the intestinal necrosis and non-intestinal necrosis groups. The clinical characteristics and laboratory data were analyzed by univariate analysis, and the variables with statistical significance were further analyzed by multivariate logistic regression analysis. The independent predictors of intestinal necrosis were determined and a logistic prediction model was established. Finally, the accuracy, sensitivity, and specificity of the model in predicting intestinal necrosis were evaluated. Results: Univariate analysis showed that white blood cell (WBC) count, blood urea nitrogen (BUN) level, neutrophil ratio, prothrombin time (PT), and LnD-dimer were associated with intestinal necrosis. According to logistic regression multivariate analysis, WBC count, BUN level and LnD-dimer were independent predictors of intestinal necrosis. These parameters were used to establish a clinical prediction model of intestinal necrosis (CPMIN) as follows: model score = 0.349×BUN (mmol/L) +0.109×WBC×109+0.394×LnD-Dimer-7.883. The area under the receiver operating characteristics (ROC) curve of the model was 0.889 (95% confidence interval: 0.833–0.944). Model scores greater than -0.1992 predicted the onset of intestinal necrosis. The accuracy, specificity, and sensitivity of the model were 82.6%, 78.2%, and 88.3%, respectively. The proportion of intestinal necrosis in the high-risk patient group (CPMIN score ≥ -0.1992) was much greater than that in the low-risk patient group (CPMIN score < -0.1992; 82.7% vs. 15.0%, p<0.001).Conclusion：The CPMIN can effectively predict intestinal necrosis and guide early surgical intervention to improve patient prognosis. Patients with AMI who are classified as high-risk should be promptly treated with surgery to avoid the potential complications caused by delayed operation. Patients classified as low-risk group can receive non-surgical treatment. This model may help to lower the morbidity and mortality from AMI.

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Predictors Of Transmural Intestinal Necrosis In Patients Presenting With Acute Mesenteric Ischemia On Computed Tomography.

Journal of Cardiovascular Computed Tomography ◽

10.1016/j.jcct.2020.06.141 ◽

2020 ◽

Vol 14 (3) ◽

pp. S72-S73

Author(s):

I. Atre ◽

K. Eurboonyanun ◽

A. O'Shea ◽

R. Lahoud ◽

A. Shih ◽

...

Keyword(s):

Computed Tomography ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis

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Mean platelet volume as a potential prognostic marker in patients with acute mesenteric ischemia–retrospective study

World Journal of Emergency Surgery ◽

10.1186/1749-7922-8-49 ◽

2013 ◽

Vol 8 (1) ◽

Cited By ~ 9

Author(s):

Fatih Altintoprak ◽

Yusuf Arslan ◽

Omer Yalkin ◽

Yener Uzunoglu ◽

Orhan Veli Ozkan

Keyword(s):

Retrospective Study ◽

Prognostic Marker ◽

Mean Platelet Volume ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Platelet Volume

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Predictive factors of intestinal necrosis in acute mesenteric ischemia

Open Medicine ◽

10.1515/med-2019-0104 ◽

2019 ◽

Vol 14 (1) ◽

pp. 883-889 ◽

Cited By ~ 1

Author(s):

Alfonso Canfora ◽

Antonio Ferronetti ◽

Gianpaolo Marte ◽

Vittorio Di Maio ◽

Claudio Mauriello ◽

...

Keyword(s):

Multivariate Analysis ◽

Organ Failure ◽

Predictive Factors ◽

Mesenteric Ischemia ◽

Disease Risk ◽

Acute Mesenteric Ischemia ◽

Serum Lactate ◽

Intestinal Necrosis ◽

Ct Findings ◽

Lactate Levels

AbstractObjectivesAcute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is mandatory.MethodsRegistered data of 55 consecutive patients admitted to our center between January 2010 and December 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correlation to its clinical spectre.ResultsTobacco use was the most statistically significant (p<0.01) cardiovascular disease risk factor involved in ITIN. Among lab tests, Serum lactate levels ˃ 2mmol/L resulted in a statistically significant association with ITIN (p=0.0001). Organ failure (defined as Marshall score> 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as predictive factors of ITIN in multivariate analysis using logistic regression (OR 49.66 and p-value 0.0021).ConclusionOur univariate and multivariate analysis identified multiple factors (Serum lactate levels ˃ 2mmol/L, Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN.

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Contemporary Management of Acute Mesenteric Ischemia in the Endovascular Era

Vascular and Endovascular Surgery ◽

10.1177/1538574418805228 ◽

2018 ◽

Vol 53 (1) ◽

pp. 42-50 ◽

Cited By ~ 10

Author(s):

Sungho Lim ◽

Pegge M. Halandras ◽

Carlos Bechara ◽

Bernadette Aulivola ◽

Paul Crisostomo

Keyword(s):

Mesenteric Ischemia ◽

Retrospective Studies ◽

Acute Mesenteric Ischemia ◽

Morbidity And Mortality ◽

Acute Ischemia ◽

High Morbidity ◽

Single Center ◽

Necrotic Bowel ◽

Open Laparotomy ◽

Mesenteric Revascularization

Objective: Acute mesenteric ischemia is a rare disease entity associated with high morbidity and mortality. Disparate etiologies and nonspecific symptoms make the diagnosis challenging and often result in delayed diagnosis and intervention. Open laparotomy with mesenteric revascularization and resection of necrotic bowel has been considered the gold standard of care. With recent advances in percutaneous catheter-directed techniques, multiple retrospective studies have demonstrated the outcomes of endovascular therapy. Herein, we review the etiology, presentation, and diagnosis of acute mesenteric ischemia with contemporary outcomes associated with both open and endovascular treatments. Methods: The PubMed electronic database was queried in the English language using the search words mesenteric, acute ischemia, embolism, thromboembolism, thrombosis, revascularization, and endovascular in various combinations. Abstracts of the relevant titles were examined to confirm their relevance and the full articles then extracted. References from extracted articles were checked for any additional relevant articles. This systematic review encompassed literature for the past 5 years (between 2011 and 2016). Results: Early diagnosis and intervention improves acute mesenteric ischemia outcomes. Early restoration of mesenteric flow minimizes morbidity and mortality. In comparison to open laparotomy with mesenteric revascularization and resection of necrotic bowel, several retrospective studies using administrative data and single-center chart reviews demonstrate noninferior outcomes of an endovascular first approach in acute arterial mesenteric occlusion. Conclusions: For acute mesenteric arterial occlusive disease, both endovascular and open revascularization techniques are viable options. Although there is lack of level 1 evidence, single-center retrospective studies and administrative database studies demonstrated that an endovascular first approach may have improved outcomes in the immediate postoperative period. However, selection and other bias in these studies necessitate the need for definitive randomized prospective studies between endovascular and open mesenteric intervention. In contrast, mesenteric venous thrombosis may be treated with systemic anticoagulation without surgical revascularization. Catheter-directed thrombectomy and thrombolysis can be considered at the discretion of the clinician.

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