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Cited by 89Abdominal vascular conditions and treatmentsOmental and Epiploic ConditionsAppendicitis Diagnosis and Management

Clinical Factors and Outcomes in Patients with Acute Mesenteric Ischemia in the Emergency Department

Huang, Hsien-Hao, Chang, Yu-Che, Yen, David Hung-Tsang, Kao, Wei-Fong, Chen, Jen-Dar, Wang, Lee-Min, Huang, Chun-I, Lee, Chen-Hsen·2005·Journal of the Chinese Medical Association
DOI 10.1016/s1726-4901(09)70165-0
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Abstract

BACKGROUND: The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). METHODS: The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 were reviewed retrospectively to obtain data about demographics, initial clinical presentations, predisposing diseases, previous medications, laboratory tests, and common findings on computed tomography scans with contrast. Only patients admitted through the ED and treated on medical or surgical wards were enrolled. RESULTS: Mean patient age was 71.1 years (range, 25-100 years). The overall mortality rate was 50%. There were no significant differences in gender, underlying disease, previous medication, initial signs and symptoms, and causes of mesenteric infarction, between survivors and non-survivors. Univariate analysis demonstrated that older age, bandemia, hepatic and renal impairment, hyperamylasemia, metabolic acidosis, hypoxia, intramural pneumatosis, and septic syndrome, were more frequent in patients who died than in those who survived (p < 0.05). Logistic regression identified the following variables as independent predictors of death: old age (odds ratio, OR, 1.077; 95% confidence interval, Cl, 1.013, 1.146; p = 0.02); bandemia (OR, 3.894; 95% Cl, 1.160, 13.074; p = 0.03); elevated serum aspartate aminotransferase (AST; OR, 4.532; 95% Cl, 1.274, 16.122; p = 0.02); increased blood urea nitrogen (BUN; OR, 7.219; 95% Cl, 1.166, 44.696; p = 0.03); and metabolic acidosis (OR, 6.604; 95% Cl, 1.804, 24.171; p < 0.01). CONCLUSION: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.

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  • Risk factors for increased mortality in AMI include advanced age, leukocytosis, high arterial lactate level in the first 24 h of admission, metabolic acidosis, bandemia, sepsis, hypoxia, hyperamylasemia, intramural pneumatosis, elapsed time between onset of symptoms and surgery more than 24 h, colon involvement, hepatic and renal impairment and multi-organ failure.

    “Risk factors for increased mortality include advanced age, leukocytosis, high arterial lactate level in the first 24 h of admission, metabolic acidosis, bandemia, sepsis, hypoxia, hyperamylasemia, intramural pneumatosis, elapsed time between onset of symptoms and surgery more than 24 h, colon involvement, hepatic and renal impairment and multi-organ failure[123-125].”

    From Ischemic bowel disease in 2021. (2021) · cites this paper as [125]

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Authors
Huang, H.-H., Chang, Y.-C., Yen, D. H.-T., Kao, W.-F., Chen, J.-D., Wang, L.-M., Huang, C.-I., & Lee, C.-H.
Affiliations
Taipei Veterans General Hospital (TW)
Corresponding author
Yen, David Hung-Tsang
ORCID
Venue
Journal of the Chinese Medical Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-07
Volume
68
Issue
7
Pages
299-306
ISSN
1726-4901 (ISSN-L)
DOI
10.1016/s1726-4901(09)70165-0
OpenAlex
W2019830760
Cited by
89
References
32
Citations by year
2026: 2 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 11 · 2021: 6 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 5 · 2014: 5 · 2013: 4 · 2012: 6
FWCI
2.22
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of the Chinese Medical Association (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Rheumatology › Omental and Epiploic Conditions
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
Keywords
acute mesenteric ischemia, mesenteric infarction, mortality risk factors, risk stratification, bandemia, metabolic acidosis, liver dysfunction, renal dysfunction, hyperamylasemia, elderly patients, emergency department diagnosis, prognostic factors, sepsis, hypoxia, serum aspartate aminotransferase
MeSH terms
Acute Disease, Adult, Aged, Aged, 80 and over, Alanine Transaminase, Blood Urea Nitrogen, Emergency Service, Hospital, Female, Humans, Ischemia, Male, Mesentery, Middle Aged, Tomography, X-Ray Computed

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