Evaluating the Risk of Irreversible Intestinal Necrosis Among Critically Ill Patients With Nonocclusive Mesenteric Ischemia.
Adult
Aged
Aged, 80 and over
Bicarbonates
/ blood
Critical Illness
Female
Humans
Intestine, Small
/ blood supply
Laparotomy
Male
Mesenteric Ischemia
/ blood
Middle Aged
Multivariate Analysis
Necrosis
Postoperative Complications
/ diagnostic imaging
Proportional Hazards Models
Prothrombin Time
Risk Assessment
Sepsis
/ complications
Tomography, X-Ray Computed
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
29
10
2020
accepted:
18
03
2021
entrez:
29
6
2021
pubmed:
30
6
2021
medline:
31
8
2021
Statut:
ppublish
Résumé
To identify factors associated with irreversible transmural necrosis (ITN) among critically ill patients experiencing nonocclusive mesenteric ischemia (NOMI) and to compare the predictive value regarding ITN risk stratification with that of the previously described Clichy score. All consecutive patients admitted to the intensive care unit between 2009 and 2019 who underwent exploratory laparotomy for NOMI and who had an available contrast-enhanced computed tomography with at least 1 portal venous phase were evaluated for inclusion. Clinical, laboratory, and radiological variables were collected. ITN was assessed on pathological reports of surgical specimens and/or on laparotomy findings in cases of open-close surgery. Factors associated with ITN were identified by univariate and multivariate analysis to derive a NOMI-ITN score. This score was further compared with the Clichy score. We identified 4 factors associated with ITN in the context of NOMI: absence of bowel enhancement, bowel thinning, plasma bicarbonate concentration ≤15 mmol/L, and prothrombin rate <40%. These factors were included in a new NOMI-ITN score, with 1 point attributed for each variable. ITN was observed in 6%, 38%, 65%, 88%, and 100% of patients with NOMI-ITN score ranging from 0 to 4, respectively. The NOMI-ITN score outperformed the Clichy score for the prediction of ITN (area under the receiver operating characteristics curve 0.882 [95% confidence interval 0.826-0.938] vs 0.674 [95% confidence interval 0.582-0.766], respectively, P < 0.001). We propose a new 4-point score aimed at stratifying risk of ITN in patients with NOMI. The Clichy score should be applied to patients with occlusive acute mesenteric ischemia only.
Identifiants
pubmed: 34183578
doi: 10.14309/ajg.0000000000001274
pii: 00000434-202107000-00024
doi:
Substances chimiques
Bicarbonates
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1506-1513Informations de copyright
Copyright © 2021 by The American College of Gastroenterology.
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