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

Zhuang, Xinsuo; Chen, Fumei; Zhou, Qian; Zhu, Yuanxun; Yang, Xiaofeng

doi:10.1186/s12876-021-01746-0

Cited by 8 publications

(12 citation statements)

References 35 publications

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“…In our multiomics model, we de ned hyponatremia, hypokalemia and rising levels of BUN as independent risk factors for StBO. In addition, insu cient renal perfusion due to extrasecretion in the intestinal lumen and the accumulation of lactic acid produced by intestinal anaerobic glycolysis deteriorate renal function with increasing levels of BUN in peripheral blood [21,33]. Consequently, the distal convoluted tubule response to aldosterone results in the reabsorption of Na+ by exchanging K+ or H+, thus, hyponatremia and hypokalemia occur [2].…”

Section: Discussionmentioning

confidence: 99%

“…The AUC of this multiomics model was 0.857 (95% CI: 0.793-0.920), which was much higher than that of the model that only consisted of radiomics [15] and equal to that of the previous CTA model [8,30] (Supplementary Table 5). According to a previous study, we calculated the scores of our multiomics model by summing the respective regression coe cients of the risk factors [21]. The formula is shown in Figure 7.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, most studies have focused on the prediction of bowel transmural necrosis in AMI [21,22,34],…”

Section: Discussionmentioning

confidence: 99%

“…To date, few studies have focused on the prediction of bowel transmural necrosis for SBO, most of which enrolled patients with acute mesenteric ischemia (AMI) [20][21][22]. Among these studies, only laboratory biomarkers were primarily considered indicative factors of bowel transmural necrosis [20,21]. To our knowledge, no efforts have been made to predict transmural necrosis in patients with SBO.…”

Section: Introductionmentioning

confidence: 99%

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Prediction and Management of Strangulated Bowel Obstruction: A Multiomics Model Analysis

Zhong

Cai

et al. 2021

Preprint

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BackgroundDistinguishing strangulated bowel obstruction (StBO) from simple bowel obstruction (SiBO) still poses a challenge for emergency surgeons. We aimed to construct a predictive model that could distinctly discriminate StBO from SiBO based on the degree of bowel ischemia.MethodsA total of 281 patients diagnosed with intestinal obstruction were enrolled. According to pathological confirmation, patients were divided into a simple bowel obstruction (SiBO, n=236) group and a strangulated bowel obstruction (StBO, n=45) group. The clinical characteristics, laboratory tests and radiomics were compared between the groups via univariate analysis. Binary logistic regression was applied to identify independent risk factors, and then predictive models based on radiomics and multiomics models were constructed. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess the accuracy of the predicted models. Finally, via stratification analysis, we validated the multiomics model in the prediction of transmural necrosis. ResultsOf the 281 patients with SBO, 45 (16.0%) were found to have StBO, while 236(84.0%) with SiBO. Via univariate analysis, clinical characteristics including pain duration (p=0.036), abdominal pain(p=0.018), tenderness (p=0.020), rebound tenderness (p<0.001), bowel sounds (p=0.014), and laboratory parameters like white blood cell (WBC) (p=0.029), neutrophil (NE)% (p=0.007), low levels of sodium (p=0.009), abnormal potassium (p=0.003), high levels of blood urea nitrogen (BUN) (p<0.001) and glucose (p=0.002), as well as the radiomics consisting of mesenteric fluid (p=0.018), ascites (p=0.002), bowel spiral signs (p<0.001) and edema of bowel wall (p=0.037) were closely related to bowel ischemia. The ascites (OR=4.067) and bowel spiral signs (OR=5.506) were identified as independent risk factors of StBO in the radiomics model, the AUC for which was 0.706 (95%CI, 0.617–0.795). In the multivariate analysis, seven risk factors including pain duration≤3days (OR=3.775), rebound tenderness (OR=5.201), low-to-absent bowel sounds (OR=5.006), low levels of potassium (OR=3.696) and sodium (OR=3.753), high levels of BUN (OR=4.349), high radiomics score (OR=11.264) were identified. The area under the receiver operating characteristics (ROC) curve of the model was 0.857(95%CI, 0.793-0.920). The score of the mutiomics model can be calculated as following formula (1.328*Pd+1.649*Rt+1.611*Bs+1.307*K+1.323*Na+1.470*BUN+2.422*Rad-6.009). In the stratification of risk scores, the proportion of patients with transmural necrosis was significantly greater in the high-risk group (24%) than in the medium-risk group (3%). No transmural necrosis was found in the low-risk group.ConclusionThe novel multiomics model consisting of risk factors for pain duration, rebound tenderness, bowel sounds, potassium, sodium, and BUN levels and radiomics offers a useful tool for predicting StBO. Clinical management can be performed according to the multiomics score; for patients with low risk (scores≤ -3.91), conservative treatment is recommended. For the high-risk group (risk scores> -1.472), there was a strong suggestion for detection with laparotomy. For the remaining patients (-3.091< risk scores ≤ -1.472), dynamic observation is suggested.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Recently, most studies have focused on the prediction of bowel transmural necrosis in AMI [21,22,34],…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction and Management of Strangulated Bowel Obstruction: A Multiomics Model Analysis

Zhong

Cai

et al. 2021

Preprint

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“…has not yet developed, patients can be treated without open surgery, using thrombolytic therapy, balloon dilatation, stent implantation or other appropriate strategies. However, if intestinal necrosis or peritonitis has already developed, open laparotomy is indicated [8,9,10]. This report presents a case of a patient with AMI due to thrombosis of SMA.…”

Section: If Intestinal Necrosismentioning

confidence: 99%

Acute Mesenteric Ischemia: Case Report

Bajoriūnaitė¹,

Balčiūnas²,

Vaiciukevičius³

et al. 2022

Health Sciences

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Acute mesenteric ischemia (AMI) is a rare cause for hospital admissions of abdominal pain with incidence of less than 0.1% but due to delay in diagnosis results in a high 40% to 80% mortality rate. Small intestine ischemia occurs due to blood supply interruption of the superior mesenteric artery (SMA) which can happen due to embolism, arterial or venous thrombosis or non occlusive ischemia. AMI is most commonly caused by SMA thrombosis, which is precipitated by dehydration, low cardiac output and hypercoagulation, or SMA embolic occlusion, which mostly occurs due to acute myocardial infarction. We present a 74-year-old man who complained of acute chest pain and pressure, black stools that started 4 hours ago. The patient had a history of prostatic hyperplasia and aortic surgery complicated by intestinal necrosis. Computed tomography (CT) showed bleeding in the duodenum, which was stopped using adrenaline. Coronary angiography was performed after cessation of bleeding. The patient began to complain of severe abdominal pain. Abdominal and pelvic contrast CT showed SMA thrombosis. The patient underwent small intestine resection, ileostomy and cystostomy. Histopathological examination revealed ischemic and necrotic changes. Despite the treatment the patient died. Physicians should be aware of AMI as a possible cause of abdominal pain, especially in elderly patients with cardiovascular comorbidities. Contrast enhanced CT should be the first-line imaging modality for differential diagnosis. Thorough assessment of symptoms and risks, timely use of diagnostic and interventional measures can help to reduce high mortality.

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Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

et al. 2022

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Background Acute mesenteric ischemia (AMI) is a devastating disease with poor prognosis. Due to the multitude of underlying factors, prediction of outcomes remains poor. We aimed to identify factors governing diagnosis and survival in AMI and develop novel prognostic tools. Methods This monocentric retrospective study analyzed patients with suspected AMI undergoing imaging between January 2014 and December 2019. Subgroup analyses were performed for patients with confirmed AMI undergoing surgery. Nomograms were calculated based on multivariable logistic regression models. Results Five hundred and thirty-nine patients underwent imaging for clinically suspected AMI, with 216 examinations showing radiological indication of AMI. Intestinal necrosis (IN) was confirmed in 125 undergoing surgery, 58 of which survived and 67 died (median 9 days after diagnosis, IQR 22). Increasing age, ASA score, pneumatosis intestinalis, and dilated bowel loops were significantly associated with presence of IN upon radiological suspicion. In contrast, decreased pH, elevated creatinine, radiological atherosclerosis, vascular occlusion (versus non-occlusive AMI), and colonic affection (compared to small bowel ischemia only) were associated with impaired survival in patients undergoing surgery. Based on the identified factors, we developed two nomograms to aid in prediction of IN upon radiological suspicion (C-Index = 0.726) and survival in patients undergoing surgery for IN (C-Index = 0.791). Conclusion As AMI remains a condition with high mortality, we identified factors predicting occurrence of IN with suspected AMI and survival when undergoing surgery for IN. We provide two new tools, which combine these parameters and might prove helpful in treatment of patients with AMI.

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

Cited by 8 publications

References 35 publications

Prediction and Management of Strangulated Bowel Obstruction: A Multiomics Model Analysis

Prediction and Management of Strangulated Bowel Obstruction: A Multiomics Model Analysis

Acute Mesenteric Ischemia: Case Report

Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

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