Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

Abstract

Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.

Delay to surgery in acute perforated and ischaemic gastrointestinal pathology: a systematic review

“…Several studies suggest the time from admission to theatre for source control is a critical determinant for survival in acute abdominal pathology. Élthes and colleagues (2018) 25 compared deceased patients with survivors in their cohort study, finding a mean time from admission to theatre of 9.10 hours compared with 5.57 hours respectively. Four studies suggested a reduced survival of 2.2–3 per cent with each additional hour of delay from admission to surgery 19 , 21 , 24 , 28 .…”

“…This compared with only 14 of 219 (6.1 per cent) patients having a delayed diagnosis when there was no delay in imaging 5 . Élthes and co-workers (2018) 25 found that, regarding acute mesenteric ischaemia (AMI), the more prolonged the investigation period in the ED, the greater the lesion progression. This was directly associated with an increase in mortality rate.…”

“…Although 80 per cent of hospitals had a dedicated emergency theatre, this is typically a single emergency theatre (107 of 127 hospitals) which is shared with other specialties 5 . Élthes and colleagues (2018) 25 found a mean time of 1.77 versus 1.42 hours in deceased versus survivors from arrival in surgery to knife-to-skin.…”

“…Quality standards are therefore in place, such as trauma patients receiving a CT within 1 hour of arrival to the ED 30 . With an acute abdominal pathology mortality rate of up to 74 per cent 25 , 26 , there is a convincing argument that fast-track pathways should be implemented similarly for emergency abdominal surgery.…”

“…While the breadth of pathologies was chosen to ensure a comprehensive picture of the problematic intervals within the pathway to theatre for patients, some abdominal pathologies carry worse prognoses than others. For example, bowel ischaemia has a particularly bad prognosis and carries a highly variable outcome depending on extent of bowel involved, that is global or segmental ischaemia 25 , 26 . The quality assessment tool used for assessing the methodological quality score of the reviewed papers ( Table 3 ) showed a range from 50–83 per cent adherence to the items which equates a medium to high reliability 12 , with interventional studies scoring higher than observational studies on average.…”