Prognostic factors of acute mesenteric ischemia in ICU patients
Open accessAbstract
BACKGROUND: The primary endpoint was to investigate the prognostic factors of acute mesenteric ischemia (AMI) in ICU patients. METHODS: Retrospective observational, non-interventional, monocentric study of a cohort of 214 ICU patients with a confirmed diagnosis of arterial AMI. RESULTS: We collected demographics, mortality, hospital stay, prior medical history, comorbidities, reasons for ICU admission, laboratory investigations, diagnostic procedures, therapy, severity scores. The 30-day mortality rate was 71% for the 214 patients with arterial AMI. The incidence of nonocclusive mesenteric ischemia was particularly high. AMI was a secondary diagnosis in 58% of patients. Half of the population was represented by surgical patients who mostly required an urgent procedure. The mortality rate was not different in the subgroup with aortic surgery. Three factors were associated with an increase or decrease in mortality: the maximal dose of vasopressors (VP) administered to the patient (OR = 1.20; 95%CI = 1.08-1.33; p < 0.001), arterial change in lactate values within the first 24 h of admission (OR = 1.24; 95%CI = 1.05-1.48; p = 0.012) and anticoagulation (OR = 0.19; 95%CI = 0.043-0.84; p = 0.029). CONCLUSIONS: Fatalities after AMI were related to a high incidence of multi-organ failure. The monitoring of arterial lactate appeared helpful to identify the patients with a poor prognosis.
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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 [124]
The Results (Comparison survivors versus non-survivors) associate higher arterial lactate, pneumatosis intestinalis, sepsis and higher creatinine with poorer outcomes; the Discussion also links prognosis to the number of organ dysfunctions. But the Discussion says age was not an independent mortality risk factor in this cohort, and the Results show no significant association for leukocyte count. The paper does not establish several other listed factors, including bandemia, hyperamylasemia and a symptom-to-surgery interval over 24 hours. (LLM, conf=0.90)
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- [25]Cudnik MT Darbha S Jones J Macedo J Stockton SW Hiestand BC The diagnosis of acute mesenteric ischemia:a systematic review andmeta-analysis Acad Emerg Med 2013 20 1087 1100 10.1111/acem.12254 24238311 · DOI · Paper page
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- Authors
- Caluwaerts, M., Castanares-Zapatero, D., Laterre, P.-F., & Hantson, P.
- Affiliations
- Cliniques Universitaires Saint-Luc (BE)
- Corresponding author
- Hantson, Philippe
- Venue
- BMC Gastroenterology
- Published
- 2019-05-30
- Volume
- 19
- Issue
- 1
- Pages
- 80-80
- ISSN
- 1471-230X (ISSN-L)
- PMC
- PMC6543602
- OpenAlex
- W2947847691
- Cited by
- 56
- References
- 29
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 11 · 2020: 6 · 2019: 1
- FWCI
- 7.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Gastroenterology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- acute mesenteric ischemia, nonocclusive mesenteric ischemia, prognostic factors, 30-day mortality, vasopressors, arterial lactate, anticoagulation, multiple organ failure, intensive care unit patients, aortic surgery
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Anticoagulants, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Multiple Organ Failure, Prognosis, Retrospective Studies, Vasoconstrictor Agents, Comorbidity, Incidence, Hospital Mortality, Sepsis, Lactic Acid, Mesenteric Ischemia
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