Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis

Wu, Wenhan; Liu, Jianbo; Zhou, Zong‐Guang

doi:10.1155/2020/1382475

Cited by 17 publications

(15 citation statements)

References 39 publications

(79 reference statements)

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“…In medical research, age is associated with high mortality in patients with AMI. 4 , 26 This was similar to the finding of our research. Our study also indicated that low blood pressure upon admission was also closely related to the hospital death of patients with AMI, which was compatible with previous medical literature.…”

Section: Discussionsupporting

confidence: 93%

“… 28 In previous studies, high serum creatinine was reported as an essential risk factor for hospital mortality of AMI. 4 , 26 Our study also indicated similar results, which highlight the importance of normal kidney function in AMI management. Besides, our study also found that elevated RDW was also an independent risk factor.…”

Section: Discussionsupporting

confidence: 83%

“… 3 However, there were still many patients who died under current treatment management, with high hospital mortality of about 40%. 4 Although AMI is an uncommon surgical emergency, whose incidence is about 0.09–0.2% per year. Unfortunately, in the situation of the aging population and the prevalence of risk factors contributing to AMI, the incidence seems to have increased.…”

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Way to Access Hospital Death Prediction Model for Acute Mesenteric Ischemia: A Combination of Traditional Statistics and Machine Learning

Wu¹,

Zhou²

2021

IJGM

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Purpose This study aimed to use traditional statistics and machine learning to develop and validate prediction models for predicting hospital death in patients with AMI and compare these models’ performance. Patients and Methods Data were retrieved from the Medical Information Mart for Intensive Care (MIMIC III) electronic clinical database. A total of 338 eligible AMI patients were divided into a training cohort (n = 238) and a validation cohort (n = 100), and all patients were divided into survival groups and nonsurvival groups according to patients’ hospital outcomes. The performance of the traditional statistics prediction model and the optimal machine learning prediction model was evaluated and compared with respect to discrimination, calibration, and clinical utility in the validation cohort. Results Univariate and multivariate logistic regression analyses identified the following independent risk factors associated with hospital death for AMI in the training cohort, including diastolic blood pressure, blood lactate, blood creatinine, age, blood pH, and red blood cell distribution width. Both the nomogram (AUC = 77.0%, 67.9–86.1%) and optimal machine learning model (AUC = 82.9%, 74.9–91.0%) achieved good discrimination and calibration in the validation cohort. Decision curves analysis showed that the optimal machine learning model has a greater net benefit than that of nomogram in this study. Conclusion The nomogram achieved a concise and relatively accurate prediction of hospital death in patients with AMI, the machine learning model also has good discrimination and seems to have better clinical utility. Traditional statistics may help infer the relationship between risk factors and hospital death, while machine learning may contribute to a more accurate prediction. Traditional statistics and machine learning are complementary in developing the prediction model for hospital death of AMI. Therefore, a combination of nomogram–machine learning (Nomo-ML) predictive model may improve care and help clinicians make AMI management-related decisions.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Way to Access Hospital Death Prediction Model for Acute Mesenteric Ischemia: A Combination of Traditional Statistics and Machine Learning

Wu¹,

Zhou²

2021

IJGM

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“…Numerous studies have examined predictors of adverse cardiovascular outcomes and mortality following Eur J Anaesthesiol 2022; 39:145-151 noncardiac surgery. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] These studies differed in their selection of patients, types of surgery, proportions of emergency procedures and extent of postoperative morbidity. We aimed to identify the definition of intraoperative tachycardia that has the strongest association with adverse postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Associations between different measures of intra-operative tachycardia during noncardiac surgery and adverse postoperative outcomes

Shcherbakov

Bisharat

2021

European Journal of Anaesthesiology

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BACKGROUND Intra-operative tachycardia during noncardiac surgery has been associated with adverse postoperative outcomes. However, harm thresholds for tachycardia have not been uniformly defined. The definition of intraoperative tachycardia that best correlates with adverse postoperative outcomes remains unclear.OBJECTIVE We aimed to identify the definition of intraoperative tachycardia during noncardiac surgery that is associated with the best predictive ability for adverse postoperative outcomes.DESIGN A single-centre retrospective cohort analysis.SETTING Secondary care hospital, Afula, Israel.PATIENTS AND METHODS Adults who underwent elective or nonelective noncardiac surgery during 2015 to 2019. Five intra-operative heart rate (HR) cut-off values and durations were applied with penalised logistic regression modelling for the outcome measures. MAIN OUTCOME MEASURESThe primary outcome was all-cause 30-day mortality; the secondary outcome was myocardial ischaemia or infarction (MI) within 30 days after noncardiac surgery. RESULTSThe derivation and validation datasets included 6490 and 4553 patients, respectively. Altogether, all-cause 30-day mortality and MI rates averaged 2.1% and 3.2%, respectively. Only two definitions of intra-operative tachycardia were significantly associated with the outcome measures: HR ! 100 bpm for ! 30 min and HR ! 120 bpm for ! 5 min. The C-statistics of the base models without tachycardia exposure for all-cause 30-day mortality and MI were 0.75 (95% confidence interval, CI, 0.74 to 0.78) and 0.73 (95% CI, 0.72 to 0.76), respectively. The addition of intra-operative tachycardia exposure to the base models significantly improved their predictive performance. The highest area under the curve (AUC) was achieved when tachycardia was defined as an intra-operative HR ! 100 bpm for at least 30 min: AUC 0.81 (95% CI, 0.80 to 0.84) and AUC 0.80 (95% CI, 0.79 to 0.82) for all-cause 30-day mortality and MI, respectively.CONCLUSION Intra-operative tachycardia, defined as an intra-operative HR ! 100 bpm for at least 30 min, was associated with the highest predictive power for adverse postoperative outcomes.

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“…Given the highly heterogenous nature of AMI and its relatively rare occurrence, only a limited number of monocentric series are available for investigating the disease. Moreover, those studies vary in design, endpoints, and findings [10,15,16], resulting in overall inconsistent and low-quality evidence. To further explore potential prognostic factors of surgical morbidity and mortality, we analyzed clinical outcomes in a European cohort of patients undergoing treatment for AMI.…”

Section: Of 13mentioning

confidence: 99%

Prognostic Factors for Mortality in Acute Mesenteric Ischemia

Otto

Czigány

Heise

et al. 2022

JCM

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Postoperative mortality in patients undergoing surgical and/or interventional treatment for acute mesenteric ischemia (AMI) has remained an unsolved problem in recent decades. Here, we investigated clinical predictors of postoperative mortality in a large European cohort of patients undergoing treatment for AMI. In total, 179 patients who underwent surgical and/or interventional treatment for AMI between 2009 and 2021 at our institution were included in this analysis. Associations between postoperative mortality and various clinical variables were assessed using univariate and multivariable binary logistic regression analysis. Most of the patients were diagnosed with arterial ischemia (AI; n = 104), while venous ischemia (VI; n = 21) and non-occlusive mesenteric ischemia (NOMI; n = 54) were present in a subset of patients. Overall inhouse mortality was 55.9% (100/179). Multivariable analyses identified leukocytes (HR = 1.08; p = 0.008), lactate (HR = 1.25; p = 0.01), bilirubin (HR = 2.05; p = 0.045), creatinine (HR = 1.48; p = 0.039), etiology (AI, VI or NOMI; p = 0.038) and portomesenteric vein gas (PMVG; HR = 23.02; p = 0.012) as independent predictors of postoperative mortality. In a subanalysis excluding patients with fatal prognosis at the first surgical exploration (n = 24), leukocytes (HR = 1.09; p = 0.004), lactate (HR = 1.27; p = 0.003), etiology (AI, VI or NOMI; p = 0.006), PMVG (HR = 17.02; p = 0.018) and intraoperative FFP transfusion (HR = 4.4; p = 0.025) were determined as independent predictors of postoperative mortality. Further, the risk of fatal outcome changed disproportionally with increased preoperative lactate values. The clinical outcome of patients with AMI was determined using a combination of pre- and intraoperative clinical and radiological characteristics. Serum lactate appears to be of major clinical importance as the risk of fatal outcome increases significantly with higher lactate values.

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Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis

Cited by 17 publications

References 39 publications

A Comprehensive Way to Access Hospital Death Prediction Model for Acute Mesenteric Ischemia: A Combination of Traditional Statistics and Machine Learning

A Comprehensive Way to Access Hospital Death Prediction Model for Acute Mesenteric Ischemia: A Combination of Traditional Statistics and Machine Learning

Associations between different measures of intra-operative tachycardia during noncardiac surgery and adverse postoperative outcomes

Prognostic Factors for Mortality in Acute Mesenteric Ischemia

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