Prognostic Factors for Mortality in Acute Mesenteric Ischemia

Abstract

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.

Mortality Prediction Model before Surgery for Acute Mesenteric Infarction: A Population-Based Study

“…After referring to previous studies, age, sex, Charlson Comorbidity Index score, and cardiac conduction disease were identified as the preoperative risk factors, and they were included in our study. Based on the details of the Charlson Comorbidity Index score, we chose 13 diseases to evaluate [ 3 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] ( Supplementary Table S1 ). The cutoff value for continuous variables was determined using receiver operating characteristics (ROC) curves.…”

“…Studies performed to date reveal that 30-day mortality is a reliable metric to determine the outcomes of surgery to treat AMI. Preoperative factors associated with 30-day mortality include patient vital parameters, comorbidities, clinical characteristics, duration between diagnosis and surgery, and intraoperative interventions [ 3 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

“…Preoperative prediction is essential to determine whether patients need to undergo a bowel resection to assess intestinal viability and determine the feasibility of reestablishing blood supply to the ischemic bowel, removing the necrotic intestine, and promoting a care-related quality-of-life improvement process. Previous studies have identified some preoperative risk factors for 30-day surgical mortality post bowel resection [ 3 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. However, few studies have involved scoring systems for predicting mortality following bowel resection, specifically among patients with AMI [ 19 , 20 ].…”

Es ist noch Luft nach oben – zur akuten mesenterialen Ischämie

“…Dennoch ist das Krankheitsbild auch im interdisziplinären Ansatz mit einer hohen Letalität verbunden. In einer rezenten Publikation, die an einer anderen Universitätsklinik die Ergebnisse von 2009–2021 untersucht hatte, und eine deutlich höhere Rekanalisierungsrate beschrieb, lag die Sterblichkeit bei 55,9 % [ 3 ]. Auch im Jahr 2022 wurden Ergebnisse aus einer weiteren Uniklinik publiziert.…”

“…Das macht die Vergleichbarkeit der Ergebnisse sehr schwierig. So lag in einer der genannten Studien in 104 von 179 Fällen ein Verschluss der A. mesenterica superior zu Grunde (58,1 %) [ 3 ]. Die „non-occlusive disease“ (NOMI, 54 Fälle, 30,2 %) hatte eine signifikant schlechtere, die venöse Thrombose ( n = 21) eine signifikant bessere Prognose.…”