Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial

Piton, Gaël; Gouge, Amélie Le; Boisramé-Helms, Julie; Anguel, Nadia; Argaud, Laurent; Asfar, Pierre; Botoc, Vlad; Bretagnol, Anne; Brisard, Laurent; Bui, Hoang-Nam; Canet, Emmanuel; Chatelier, D.; Chauvelot, Louis; Darmon, Michaël; Das, Vincent; Devaquet, Jérôme; Djibré, Michel; Ganster, Frédérique; Garrouste-Orgeas, Maïté; Gaudry, Stéphane; Gontier, Olivier; Groyer, Samuel; Guidet, Bertrand; Herbrecht, Jean-Étienne; Hourmant, Yannick; Lachérade, Jean-Claude; Letocart, Philippe; Martino, Frédéric; Maxime, Virginie; Mercier, Emmanuelle; Mira, Jean‐Paul; Nseir, Saad; Quenot, Jean-Pierre; Richecoeur, Jack; Rigaud, Jean‐Philippe; Roux, Damien; Schnell, David; Schwebel, Carole; Silva, Daniel; Sirodot, Michel; Souweine, Bertrand; Thieulot-Rolin, Nathalie; Tinturier, F.; Tirot, P.; Thévenin, Didier; Thiéry, Guillaume; Lascarrou, Jean-Baptiste; Reignier, Jean

doi:10.1007/s00134-022-06637-w

Cited by 41 publications

(47 citation statements)

References 23 publications

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“…On the other hand, the median SAPS II scores were lower than those reported by Piton et al [ 8 ] have reported in the NUTRIREA2 trial (39 vs 59). [ 8 ] Viswanathan et al [ 19 ] have reported higher SOFA scores both in survivors and non-survivors compared to our study (3 vs 8.82; 8 vs 12.86, respectively). [ 19 ]…”

Section: Discussioncontrasting

confidence: 61%

“…In the present study, we found that the scores of the rating systems were higher in the non-survivor groups than in the surviving group, as shown in previous studies. [ 7 , 8 ] The median APACHE II scores in both survival groups were higher than those reported by Wu et al [ 7 ] (13 vs 11.9; 21.5 vs 14.3, respectively). On the other hand, the median SAPS II scores were lower than those reported by Piton et al [ 8 ] have reported in the NUTRIREA2 trial (39 vs 59).…”

Section: Discussionmentioning

confidence: 68%

“…[ 7 , 8 ] The median APACHE II scores in both survival groups were higher than those reported by Wu et al [ 7 ] (13 vs 11.9; 21.5 vs 14.3, respectively). On the other hand, the median SAPS II scores were lower than those reported by Piton et al [ 8 ] have reported in the NUTRIREA2 trial (39 vs 59). [ 8 ] Viswanathan et al [ 19 ] have reported higher SOFA scores both in survivors and non-survivors compared to our study (3 vs 8.82; 8 vs 12.86, respectively).…”

Section: Discussionmentioning

confidence: 90%

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Are the conventional scoring systems efficient in predicting mortality of acute mesenteric ischemia?: Mortality estimation in patients with AMI

et al. 2022

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Acute mesenteric ischemia is a surgical emergency with high morbidity and mortality rates. Therefore, it is important to determine the prognosis for this disease. In the present study, we aimed to compare the prediction accuracy of 3 scoring systems: Acute physiology and chronic health evaluation II, sequential organ failure assessment score and simplified acute physiology score II (SAPS II). The retrospective cohort study was conducted in a university hospital. Eighty-two acute mesenteric ischemia patients were evaluated retrospectively. The mortality prediction abilities of the scoring systems were evaluated by comparing the prediction rates of > 10%, 30% and 50% and the actual mortality among survivors and non-survivors in pairs. Predicted mortality rates among survivors and non-survivors differed among the 3 classification systems. The mortality estimates of the SAPS II were closer to the actual mortality rates. Analysis of the estimated mortality rates as mortality risk limits showed that acute physiology and chronic health evaluation II was superior to sequential organ failure assessment score and SAPS II in estimating mortality rates, whereas SAPS II was more successful in detecting survivors. The estimated mortality rates of the 3 rating systems, the estimated mortality rates were higher in the non-survivor group than in the survivor group. The accuracy of the SAPS II in determining prognosis was relatively better.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 90%

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Are the conventional scoring systems efficient in predicting mortality of acute mesenteric ischemia?: Mortality estimation in patients with AMI

et al. 2022

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“…In addition, in a recent study by Ortiz‐Reyes et al, early enteral nutrition showed no benefit compared to delayed enteral in ventilated patients receiving vasopressor or inotropic therapies after adjusting for the illness severity [ 18 ]. Finally, some concerns have recently emerged about the possible increased risk of digestive complications such as mesenteric ischaemia associated with early enteral feeding [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

et al. 2023

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Background Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. Methods The ‘French-Speaking ICU Nutritional Survey’ (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11). Conclusions In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.

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“…Hence, duration of low flow state and catecholamine infusion are established risk factors of NOMI. Two additional risk factors have been recently described [ 10 ]: enteral nutrition, which can be considered as a stress effort on the gut, and the low cardiac output and; thus, decreased oxygen delivery to the gut, highlighted by dobutamine requirement.…”

Section: Introductionmentioning

confidence: 99%

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Konan

Piton²,

Ronot

et al. 2022

Ann. Intensive Care

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Background Although risk factors of occlusive acute mesenteric ischemia are well known, triggering factors of nonocclusive mesenteric ischemia (NOMI) remain unclear. Alongside to the known risk factors for NOMI, the role of atherosclerosis is not fully elucidated. The purpose of our study was to evaluate whether abdominal atherosclerosis is a risk factor for NOMI. Methods From January 2018 to December 2021, all consecutive patients admitted to the intensive care unit who underwent contrast-enhanced CT for suspicion of NOMI were evaluated for inclusion. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. The cohorts were matched by a 1:1 propensity score based on the patient clinical, biological data, and abdominal CT features associated with NOMI. Noncontrast CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA), and common iliac artery according to the Agatston method. Analyses were performed before and after propensity score matching. Results Among the 165 critically ill patients included, 59 (36%) had NOMI. Before matching analysis, the SMA and total abdominal Agatston calcium scores were not different between patients without and with NOMI (52.00 [IQR = 0, 473] vs. 137.00 [IQR = 0, 259], P = 0.857, respectively, and 7253 [IQR = 1220, 21738] versus 5802 [IQR = 2075, 15,084]; P = 0.723). The results were similar after matching 38 patients with NOMI and 38 without: 153 [IQR = 0, 665] versus 85 [IQR = 0, 240] (P = 0.312) for the SMA calcium score, and 7915 [IQR = 1812, 21561] versus 4139 [IQR = 1440, 9858] (P = 0.170) for the total abdominal Agatston calcium score. Conclusion Our results suggest that atherosclerosis is not a risk factor for NOMI in critically ill patients.

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Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial

Cited by 41 publications

References 23 publications

Are the conventional scoring systems efficient in predicting mortality of acute mesenteric ischemia?: Mortality estimation in patients with AMI

Are the conventional scoring systems efficient in predicting mortality of acute mesenteric ischemia?: Mortality estimation in patients with AMI

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

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