New Prediction Rule for Mortality in Acute Mesenteric Ischemia

Abstract

Objective: Acute mesenteric ischemia is potentially fatal, but prognostic factors have not yet been established. This study was undertaken to elucidate them. Methods: This is a retrospective cohort study, consisting of 110 patients who had been treated in the past 5 years, from 26 national hospitals in Japan. Results: The overall in-hospital mortality rate was 51%. Logistic regression analysis demonstrated two independent prognostic factors, electrocardiogram scale with an odds ratio of 1.7 (95% CI 1.2–2.4) and shock index of 11 (95% CI 1.5–80). A stepwise analysis gave a prediction equation for in-hospital mortality (R) using these variables and age score. We further modified this equation to a simpler scoring system (S) using the same variables. Both R and S showed a good discriminatory ability as determined by areas under the receiver-operating characteristic curve (0.83, 95% CI: 0.74–0.91 for R; 0.82, 95% CI 0.74–0.91 for S). The observed mortality rates increased as the R or S increased (19% at R <0.25, 41% at 0.25 ≤ R <0.6, 85% at R ≥0.6; 19% at S ≤2, 37% at S of 3 or 4, 91% at S ≥5). Conclusion: The new prediction rules can be used at any hospital and may be promising tools for medical decision-making, informed consent and reviewing quality of care.

Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases

“…Several independent factors of mortality and protective factors have already been reported. As elsewhere [7][8][9], we confirmed that advanced age is an independent risk factor of mortality. Initial surgical management of AMI, i.e., performed within the first 24 h of AMI diagnosis, was associated with improved outcomes.…”

Predicting the future development of depression or PTSD after injury

“…This is the first step of developing new tools for risk assessment, and findings in a variety of medical specialties are typically reported on new screeners at this point in their development [43–45]. It will be important to establish the predictive validity of the screen in additional prospective studies across a variety of injured populations in geographically diverse locations with demographically diverse and larger samples.…”

ESTES guidelines: acute mesenteric ischaemia

“…AMI accounts for about 1:1000 acute hospital admissions in Europe and the USA [ 1 ]. In Japan, where the incidence of vascular disease is lower, this figure has been estimated at 1:10,000 [ 2 ]. The incidence appears to be increasing due to an ageing general population with increasing prevalence of comorbidities.…”