Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia.
Bowel ischemia
Comorbidity
Microcirculation
SOFA
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
03 06 2022
03 06 2022
Historique:
received:
02
02
2022
accepted:
22
05
2022
entrez:
6
6
2022
pubmed:
7
6
2022
medline:
9
6
2022
Statut:
epublish
Résumé
The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI. Patients with bowel ischemia were identified by searching for "ICD-10 code K550" in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled. Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096-0.58). The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy.
Sections du résumé
BACKGROUND
The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI.
METHODS
Patients with bowel ischemia were identified by searching for "ICD-10 code K550" in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled.
RESULTS
Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096-0.58).
CONCLUSIONS
The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy.
Identifiants
pubmed: 35659015
doi: 10.1186/s13017-022-00436-w
pii: 10.1186/s13017-022-00436-w
pmc: PMC9166604
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32Informations de copyright
© 2022. The Author(s).
Références
World J Gastroenterol. 2012 Feb 7;18(5):453-7
pubmed: 22346251
BMC Gastroenterol. 2018 Jun 28;18(1):100
pubmed: 29954324
Heart Vessels. 2020 May;35(5):630-636
pubmed: 31679059
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Eur J Radiol. 2010 Oct;76(1):96-102
pubmed: 19501999
N Engl J Med. 2016 Mar 10;374(10):959-68
pubmed: 26962730
Crit Care Med. 1998 Nov;26(11):1793-800
pubmed: 9824069
J Gastrointest Surg. 2014 Sep;18(9):1642-7
pubmed: 24990124
Ann Surg. 1978 Mar;187(3):281-7
pubmed: 637584
Ann Intensive Care. 2016 Dec;6(1):112
pubmed: 27858375
J Cardiothorac Surg. 2018 Nov 16;13(1):115
pubmed: 30445964
Br J Anaesth. 2000 Jul;85(1):109-17
pubmed: 10927999
World J Surg. 2020 Nov;44(11):3687-3694
pubmed: 32661691
World J Radiol. 2014 May 28;6(5):130-8
pubmed: 24876917
Anesthesiology. 2004 Feb;100(2):434-9
pubmed: 14739821
Br J Radiol. 2018 Jan;91(1081):20170492
pubmed: 28972809
Ann Surg. 2007 Aug;246(2):229-35
pubmed: 17667501
J Cardiothorac Vasc Anesth. 2019 May;33(5):1290-1297
pubmed: 30245114
Eur Radiol. 2002 May;12(5):1179-87
pubmed: 11976865
J Intensive Care Med. 2019 Oct;34(10):771-781
pubmed: 30037271