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

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.

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

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.

scholarly journals Retrospective study of mesenteric ischemia

2020 ◽  
Vol 7 (8) ◽  
pp. 2544
Author(s):  
Mallikarjuna Reddy Mandapati ◽  
Sanjeev Kumar Jukuri ◽  
Nageswara Rao Nasika ◽  
Haleema Neshat
Keyword(s):  
Risk Factors ◽  
Small Intestine ◽  
Retrospective Study ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Delay Group ◽  
Late Mortality ◽  
Intestinal Necrosis ◽  
Life Threatening ◽  
Overall Mortality

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.

Acute mesenteric ischemia: analysis of cases admitted to a hospital during 10 years (2001–2010)

2012 ◽  
Vol 153 (36) ◽  
pp. 1424-1432 ◽  
Author(s):  
Erzsébet Szabóné Révész
Keyword(s):  
Survival Rate ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
Mesenteric Ischemia ◽  
Surgical Intervention ◽  
Acute Mesenteric Ischemia ◽  
Intestinal Necrosis ◽  
Acute Surgery ◽  
The Poor ◽  
Study Results

Acute mesenteric ischemia is a rare disorder; it occurs in an average of 0.4% of acute surgery cases. Its diagnosis is often difficult because of the poor symptoms, and mortality of the patients is still as high as 70–90%. Aims: The aims of the study were to assess the importance of time factor that may influence the outcome of the disease and to find out whether it is possible to decrease the high mortality of patients. Method: Among patients admitted to Szent Pantaleon Hospital in Hungary between January 2001 and December 2010, patients whose surgery or autopsy findings confirmed intestinal necrosis were analyzed. A total of 114 patients with acute mesenteric ischemia were included in the study. Results: 55% of the patients had typical symptoms. 43.8% of the patients underwent surgery and among these patients the mortality rate was 70% despite surgical intervention. The survival rate was 72.3% when surgery was performed within less than 12 hours after the onset of symptoms, but only 20% of patients survived when surgery was delayed between 24 and 48 hours after the onset of symptoms. Conclusion: With early diagnosis and intervention, patients with acute mesenteric ischemia may have a better a chance to survive. Orv. Hetil., 2012, 153, 1424–1432.

scholarly journals Predictive factors of intestinal necrosis in acute mesenteric ischemia

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 883-889 ◽  
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.

scholarly journals Complications and Neurological Outcome Following Intraoperative Aneurysm Rupture in Adult Patients Undergoing Intracranial Aneurysmal Clipping: A Retrospective Study

2021 ◽  
Author(s):  
Nayani Radhakrishna ◽  
Ankur Khandelwal ◽  
Rajendra Singh Chouhan ◽  
Mihir Prakash Pandia ◽  
Sourav Burman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Neurological Outcome ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Adult Patients ◽  
Multiple Logistic Regression ◽  
Duration Of Surgery

Abstract Background Intraoperative aneurysmal rupture (IAR) is a catastrophic complication; however, its impact on neurological outcome is debatable. We studied the effects of IAR on intraoperative and postoperative complications and neurological outcome. Methods In this retrospective study, adult patients who underwent aneurysmal clipping over a period of 2 years were divided as follows: group R (with IAR) and group N (without IAR). Various perioperative parameters, intraoperative and postoperative complications were noted. Glasgow outcome scale (GOS) was noted at discharge from hospital and categorized as favorable (GOS IV and V) and unfavorable (GOS I, II and III). Collected data was statistically analyzed. Univariate and multiple logistic regression analyses were performed to identify predictors of IAR. A p value < 0.05 was considered significant. Results Thirty-two out of 195 (16.41%) patients suffered IAR, with majority involving anterior communicating artery aneurysm (46.88%). Duration of temporary clipping (p < 0.001), volume of blood loss, and fluid and blood transfusion were significantly more in group R. Postoperatively, significantly more patients in group R developed intracranial hematoma, cerebral infarct, and required prolonged ventilatory support (≥5 days). Unfavorable neurological outcome was observed more in group R (p = 0.013). In univariate analysis, blood loss > 500 mL, use of colloids, and duration of surgery > 5 hours were found to be associated with IAR. After multiple logistic regression analysis, only use of colloids and duration of surgery > 5 hours were the most predictive variables for IAR. Conclusions IAR is associated with serious intraoperative and postoperative complications and unfavorable neurological outcome.

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