Predictors of response to intra-arterial vasodilatory therapy of non-occlusive mesenteric ischemia in patients with severe shock: Results from a prospective observational study
Open accessPublished version of a preprint
Abstract
BACKGROUND: Non-occlusive mesenteric ischemia (NOMI) is a life-threatening condition occurring in patients with shock and is characterized by vasoconstriction of the mesenteric arteries leading to intestinal ischemia and multi-organ failure. Although minimal invasive local intra-arterial infusion of vasodilators into the mesenteric circulation has been suggested as a therapeutic option in NOMI, current knowledge is based on retrospective case series and it remains unclear which patients might benefit. Here, we prospectively analyzed predictors of response to intra-arterial therapy in patients with NOMI. METHODS: This is a prospective single-center observational study to analyze improvement of ischemia (indicated by reduction of blood lactate > 2 mmol/l from baseline after 24 h, primary endpoint) and 28-day mortality (key secondary endpoint) in patients with NOMI undergoing intra-arterial vasodilatory therapy. Predictors of response to therapy concerning primary and key secondary endpoint were identified using a) clinical parameters as well as b) data from 2D-perfusion angiography and c) experimental biomarkers of intestinal injury. RESULTS: A total of 42 patients were included into this study. At inclusion patients had severe shock, indicated by high doses of norepinephrine (NE) (median (interquartile range (IQR)) 0.37 (0.21-0.60) μg/kg/min), elevated lactate concentrations (9.2 (5.2-13) mmol/l) and multi-organ failure. Patients showed a continuous reduction of lactate following intra-arterial prostaglandin infusion (baseline: (9.2 (5.2-13) mmol/l vs. 24 h: 4.4 (2.5-9.1) mmol/l, p < 0.001) with 22 patients (52.4%) reaching a lactate reduction > 2 mmol/l at 24 h following intervention. Initial higher lactate concentrations and lower NE doses at baseline were independent predictors of an improvement of ischemia. 28-day mortality was 59% in patients with a reduction of lactate > 2 mmol/l 24 h after inclusion, while it was 85% in all other patients (hazard ratio 0.409; 95% CI, 0.14-0.631, p = 0.005). CONCLUSIONS: A reduction of lactate concentrations was observed following implementation of intra-arterial therapy, and lactate reduction was associated with better survival. Our findings concerning outcome predictors in NOMI patients undergoing intra-arterial prostaglandin therapy might help designing a randomized controlled trial to further investigate this therapeutic approach. Trial registration Retrospectively registered on January 22, 2020, at clinicaltrials.gov (REPERFUSE, NCT04235634), https://clinicaltrials.gov/ct2/show/NCT04235634?cond=NOMI&draw=2&rank=1 .
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Continuous prostaglandin infusion can reduce lactate concentrations and enhance survival in nonocclusive mesenteric ischemia.
“Recent studies indicate continuous prostaglandin infusion can reduce lactate concentrations and enhance survival in nonocclusive mesenteric ischemia [35].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [35]
The Results (Clinical endpoints; page not provided) report that lactate concentrations declined after continuous intra-arterial prostaglandin infusion. The Conclusions and Discussion (pages not provided) associate lactate reduction with better survival, but this uncontrolled study does not establish that the infusion itself enhances survival. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn a study of 42 patients with NOMI, intra-arterial prostaglandin E1 gave a better reduction in lactate levels than standard care.
“In a study of 42 patients with NOMI, intra-arterial prostaglandin E1 gave a better reduction in lactate levels than standard care.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [201]
Table 1 in Results identifies a cohort of 42, and the Clinical endpoints section reports that lactate levels declined after intra-arterial prostaglandin therapy. But the Discussion explicitly says the study lacked a control group, so it cannot establish a better lactate reduction than standard care. (LLM, conf=0.92)
Experimental — accuracy not yet measuredThe overall 28 day mortality rate was 30/42 (71.4%).
“The overall 28 day mortality rate was 30/42 (71.4%). 201”
Endovascular revascularization can have similar perioperative outcomes to open surgery but higher rates of late technical failure with symptom recurrence and need for reintervention.
“comparative studies have suggested that endovascular revascularization can have similar perioperative outcomes to traditional open surgical interventions but demonstrate higher rates of late technical failure with symptom recurrence and need for reintervention [35,70].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [35]
The Background describes a study of intra-arterial vasodilator therapy for non-occlusive mesenteric ischemia, not a comparison of endovascular revascularization with open surgery. The Discussion states that the study lacked a control group. Searches for perioperative comparisons, late technical failure, symptom recurrence, and reintervention found no passage addressing those claims (page numbers unavailable). (LLM, conf=0.78)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Vincent, J. L., Moreno, R., Takala, J., Willatts, S., De Mendonça, A., Bruining, H., Reinhart, C. K., Suter, P. M., & Thijs, L. G. (1996) · Intensive Care Medicine · doi:10.1007/bf01709751 · Cited by 11,674 · see citing works
Vincent, J.-L., de Mendonca, A., Cantraine, F., Moreno, R., Takala, J., Suter, P. M., Sprung, C. L., Colardyn, F., & Blecher, S. (1998) · Critical Care Medicine · doi:10.1097/00003246-199811000-00016 · Cited by 3,463 · see citing works
Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients
Ferreira, F. L. (2001) · JAMA · doi:10.1001/jama.286.14.1754 · Cited by 2,862 · see citing works
Clair, D. G., & Beach, J. M. (2016) · New England Journal of Medicine · doi:10.1056/nejmra1503884 · Cited by 589 · see citing works
ESTES guidelines: acute mesenteric ischaemia
Tilsed, J. V. T., Casamassima, A., Kurihara, H., Mariani, D., Martinez, I., Pereira, J., Ponchietti, L., Shamiyeh, A., al-Ayoubi, F., Barco, L. A. B., et al. (2016) · European Journal of Trauma and Emergency Surgery · doi:10.1007/s00068-016-0634-0 · Cited by 382 · see citing works
Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy
Trompeter, M., Brazda, T., Remy, C. T., Vestring, T., & Reimer, P. (2002) · European Radiology · doi:10.1007/s00330-001-1220-2 · Cited by 378 · see citing works
Infarction of the Bowel in Cardiac Failure
Ende, N. (1958) · New England Journal of Medicine · doi:10.1056/nejm195805012581804 · Cited by 272 · see citing works
Early Diagnosis of Intestinal Ischemia Using Urinary and Plasma Fatty Acid Binding Proteins
Thuijls, G., Wijck, K. V., Grootjans, J., Derikx, J. P. M., van Bijnen, A. A., Heineman, E., Dejong, C. H. C., Buurman, W. A., & Poeze, M. (2011) · Annals of Surgery · doi:10.1097/sla.0b013e318207a767 · Cited by 217 · see citing works
Schellekens, D. H. S. M., Grootjans, J., Dello, S. A. W. G., van Bijnen, A. A. J. H. M., van Dam, R. M., Dejong, C. H. C., Derikx, J. P. M., & Buurman, W. A. (2013) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e3182a87e3e · Cited by 142 · see citing works
Biomarkers of gut barrier failure in the ICU.
Piton, G., & Capellier, G. (2016) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000283 · Cited by 126 · see citing works
Al-Diery, H., Phillips, A., Evennett, N., Pandanaboyana, S., Gilham, M., & Windsor, J. A. (2019) · Journal of Intensive Care Medicine · doi:10.1177/0885066618788827 · Cited by 117 · see citing works
Sun, D., Cen, Y., Li, S., Li, W., Lu, Q., & Xu, P. (2016) · Scientific Reports · doi:10.1038/srep34371 · Cited by 87 · see citing works
Samel, S. T., Keese, M. A., Kleczka, M., Lanig, S., Gretz, N., Hafner, M., Sturm, J. W., & Post, S. (2002) · BMC Surgery · doi:10.1186/1471-2482-2-6 · Cited by 72 · see citing works
Stahl, K., Busch, M., Maschke, S. K., Schneider, A. S., Manns, M. P., Fuge, J., Wiesner, O., Meyer, B., Hoeper, M. M., Hinrichs, J. B., et al. (2019) · Journal of Intensive Care Medicine · doi:10.1177/0885066619837911 · Cited by 50 · see citing works
Self-citationTwo-Dimensional Perfusion Angiography of the Foot
Murray, T. E., Rodt, T., & Lee, M. J. (2015) · Journal of Endovascular Therapy · doi:10.1177/1526602815621289 · Cited by 44 · see citing works
SM22 a Plasma Biomarker for Human Transmural Intestinal Ischemia
Schellekens, D. H. S. M., Reisinger, K. W., Lenaerts, K., Hadfoune, M., Damink, S. W. M. O., Buurman, W. A., Dejong, C. H. C., & Derikx, J. P. M. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000002278 · Cited by 44 · see citing works
Monbaliu, D. R. L., de Vries, B., Crabbé, T., van Heurn, E. L. W., Verwaest, C., Roskams, T., Fevery, J., Pirenne, J., & Buurman, W. A. (2005) · Transplantation Proceedings · doi:10.1016/j.transproceed.2004.12.103 · Cited by 43 · see citing works
Soussi, S., Taccori, M., de Tymowski, C., Dépret, F., Chaussard, M., Fratani, A., Jully, M., Cupaciu, A., Ferry, A., Benyamina, M., et al. (2018) · Shock · doi:10.1097/shk.0000000000001140 · Cited by 41 · see citing works
Winzer, R., Fedders, D., Backes, M., Ittermann, T., Gründling, M., Mensel, B., Held, H.-C., Kromrey, M.-L., Weitz, J., Hoffmann, R.-T., et al. (2020) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-020-02515-4 · Cited by 41 · see citing works
[Diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI)].
Stöckmann, H., Roblick, U. J., Kluge, N., Kunze, U., Schimmelpenning, H., Kujath, P., Müller, G. H., & Bruch, H. ‐. (2000) · PubMed · Cited by 40 · see citing works
Aktuelle Diagnostik und Therapie der nicht okklusiven mesenterialen Ischämie
Ernst, S., Luther, B., Zimmermann, N., Böhner, H., Wilke, R., Feindt, P. R., & Fürst, G. (2003) · RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren · doi:10.1055/s-2003-38441 · Cited by 35 · see citing works
Stahl, K., Rittgerodt, N., Busch, M., Maschke, S. K., Schneider, A., Manns, M. P., Fuge, J., Meyer, B. C., Hoeper, M. M., Hinrichs, J. B., et al. (2020) · Journal of Intensive Care Medicine · doi:10.1177/0885066619879884 · Cited by 33 · see citing works
Self-citationMinko, P., Stroeder, J., Groesdonk, H. V., Graeber, S. M., Klingele, M., Buecker, A., Schäfers, H., & Katoh, M. (2014) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-014-0844-y · Cited by 30 · see citing works
Minko, P., Groesdonk, H. V., Stroeder, J., Miodek, J., Graeber, S. M., Bücker, A., Schäfers, H., & Katoh, M. (2012) · RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren · doi:10.1055/s-0032-1312750 · Cited by 27 · see citing works
Non-okklusive Darmischämie: Radiologische Diagnostik und Therapie
Krämer, S. C., Görich, J., Oertel, F., Scheld, H. H., & Heindel, W. L. (2003) · RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren · doi:10.1055/s-2003-41923 · Cited by 24 · see citing works
Early Diagnosis of Intestinal Ischemia Using Urinary and Plasma Fatty Acid Binding Proteins
Thuijls, G., van Wijck, K., & Grootjans, J. (2011) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.07.061 · Cited by 20 · see citing works
Aktueller Stand der Diagnostik und Therapie der nicht-okklusiven Darmischämie (NOD)
Schindler, G., & Bruch, H.-P. (1991) · RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren · doi:10.1055/s-2008-1033232 · Cited by 9 · see citing works
Fujiwara, S., Sekine, Y., Nishimura, R., Tadasa, K., & Miyazaki, S. (2018) · Surgical Case Reports · doi:10.1186/s40792-017-0412-1 · Cited by 7 · see citing works
Calame, P., Nuzzo, A., & Ronot, M. (2020) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-020-02696-y · Cited by 6 · see citing works
Yoshimaru, K., Matsuura, T., Yanagi, Y., Takahashi, Y., Kohashi, K., Kaku, N., Oda, Y., Ohga, S., & Taguchi, T. (2020) · Transplantation Proceedings · doi:10.1016/j.transproceed.2020.06.010 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Lin, D., Zhang, Y., Wang, S., Zhang, H., Gao, C., Lu, F., Li, M., Chen, D., Lin, Z., & Yang, B. (2023) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2023.125370 · Cited by 38 · see citing works
Zhang, W., Zhou, B., Yang, X. F., Zhao, J., Hu, J., Ding, Y., Zhan, S., Yang, Y., Chen, J., Zhang, F., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-41147-3 · Cited by 37 · see citing works
Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review
Gries, J. J., Sakamoto, T., Chen, B., Virk, H. U. H., Alam, M., & Krittanawong, C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13051217 · Cited by 19 · see citing works
“If endovascular revascularization approaches are undertaken, then combination therapies, such as stent thrombectomy plus aspiration, should be performed due to higher clearance rates, reduced adjunctive thrombolysis, and shorter hospitalization.”
BackgroundLakbar, I., Delamarre, L., Tamme, K., Torre, N. H. D. L., Pensier, J., Monet, C., Starkopf, J., Capdevila, M., Léone, M., JONG, A. D., et al. (2025) · Intensive Care Medicine · doi:10.1007/s00134-025-07980-4 · Cited by 14 · see citing works
Zhou, Y., He, H., Cui, N., Wang, X., Long, Y., & Liu, D. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02046-8 · Cited by 12 · see citing works
Reintam Blaser, A., Forbes, A., & Björck, M. (2022) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000972 · Cited by 9 · see citing works
Non-Occlusive Mesenteric Ischemia in Cardiac Arrest Patients
Šmalcová, J., & Bělohlávek, J. (2023) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2409262 · Cited by 6 · see citing works
Ohira, G., Hayano, K., Tochigi, T., Maruyama, T., Toyozumi, T., Kurata, Y., Maruyama, M., Arai, S., Nakada, T., & Matsubara, H. (2024) · Surgery Today · doi:10.1007/s00595-024-02909-8 · Cited by 5 · see citing works
Joh, D. B., Morreau, M., Lee, A., Pendharkar, S. A., Stokes, B., Warren, R., Hickey, A. J., Phillips, A. R. J., & Windsor, J. A. (2022) · ANZ Journal of Surgery · doi:10.1111/ans.18211 · Cited by 5 · see citing works
Tricky acute mesenteric ischemia: what can we do?
Cui, X.-Y., Chen, Y., Guan, G., Luo, F., & Zhang, Z. (2025) · Gastroenterology Report · doi:10.1093/gastro/goaf067 · Cited by 2 · see citing works
Lian, C., Xu, Q., Shi, H., Xie, Y., Fang, J., Rao, B., Ji, T., Jiang, H., Wu, Z., Chen, X., et al. (2026) · Clinical Epigenetics · doi:10.1186/s13148-026-02129-6 · Cited by 2 · see citing works
Zhou, Y., He, H., Cui, N., Wang, X., Long, Y., & Liu, D. (2023) · Frontiers in Surgery · doi:10.3389/fsurg.2022.1049753 · Cited by 2 · see citing works
Nonocclusive Mesenteric Ischemia: A Review for Interventional Radiologists
Kawada, H., Nagata, S., Noda, Y., Kawai, N., Ando, T., Kaga, T., Suto, T., Kondo, H., & Matsuo, M. (2024) · Interventional Radiology · doi:10.22575/interventionalradiology.2023-0026 · Cited by 3 · see citing works
Stahl, K., Bode, C., & David, S. (2024) · Intensive Care Medicine · doi:10.1007/s00134-024-07403-w · Cited by 2 · see citing works
Self-citationAssociation of Perioperative Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia
Takami, T., Mizuno, K., Obama, K., & Kawakami, K. (2025) · Journal of Surgical Research · doi:10.1016/j.jss.2025.08.017 · Cited by 1 · see citing works
A case of non-occlusive mesenteric ischemia following hepatocellular carcinoma rupture
Radosavaljevic, I., Miwa, T., Kawade, M., Unome, S., Imai, K., Takai, K., Yamaji, F., Fukuta, T., Nomura, S., & Shimizu, M. (2024) · Clinical Journal of Gastroenterology · doi:10.1007/s12328-024-02051-5 · Cited by 1 · see citing works
Ishiki, Y., Takiguchi, T., Kim, S., Arai, M., Ishii, H., Hagiwara, J., Hagiwara, O., Ogasawara, T., Teraoka, S., Ogawa, F., et al. (2023) · Trauma Case Reports · doi:10.1016/j.tcr.2023.100904 · Cited by 1 · see citing works
Computed Tomography Imaging of Acute Mesenteric Ischemia for Interventional Radiology
Inoue, A., Chatani, S., Uemura, R., Imai, Y., Tomozawa, Y., Murakami, Y., Sonoda, A., Roberts, N., & Watanabe, Y. (2024) · Interventional Radiology · doi:10.22575/interventionalradiology.2024-0013 · Cited by 1 · see citing works
Yuankai, Z., He, H., Cui, N., Wang, X., Long, Y., & Liu, D. (2023) · Figshare · doi:10.6084/m9.figshare.22679511
Yuankai, Z., He, H., Cui, N., Wang, X., Long, Y., & Liu, D. (2023) · Figshare · doi:10.6084/m9.figshare.22679505
Zhou, Y., He, H., Cui, N., Wang, X., Long, Y., & Liu, D. (2023) · Figshare · doi:10.6084/m9.figshare.22679508
Management of ischaemic bowel in the ICU patient
Blaser, A. R., Casian, D., & Lakbar, I. (2026) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001361
NON-OCCLUSIVE FORMS OF MESENTERIC ISCHEMIA
Otdelnov, L. A., & Веселова, В. П. (2026) · Bulletin of Pirogov National Medical & Surgical Center · doi:10.25881/20728255_2026_21_2_123
Kourgiali, C. G., Gotti, K.-K. E., Velikoudi, M. D., & Chatzelas, D. A. (2026) · Cureus · doi:10.7759/cureus.114102
Pape, T., Wendel‐Garcia, P. D., Rittgerodt, N., Nalbant, B., Hinrichs, J., Becker, L. S., Hunkemöller, A. M., Raith, J., Boblitz, S. K. J., Ruwisch, J., et al. (2026) · Intensive Care Medicine Experimental · doi:10.1186/s40635-026-00963-9
Self-citation
- Authors
- Rittgerodt, N., Pape, T., Busch, M., Becker, L. S., Schneider, A., Wedemeyer, H., Seeliger, B., Schmidt, J., Hunkemöller, A. M., Fuge, J., Knitsch, W., Fegbeutel, C., Gillmann, H.-J., Meyer, B. C., Hoeper, M. M., Hinrichs, J. B., David, S., & Stahl, K.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Stahl, Klaus
- ORCID
- Venue
- Critical Care
- Published
- 2022-04-04
- Volume
- 26
- Issue
- 1
- Pages
- 92-92
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC8981621
- OpenAlex
- W4226097275
- Cited by
- 26
- References
- 30
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 2
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Deutsche Forschungsgemeinschaft (DA1209/4-3)
- Medizinische Hochschule Hannover (MHH)
- 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
- nonocclusive mesenteric ischemia, prostaglandin infusion, severe shock, predictors of treatment response, blood lactate, norepinephrine dose, 28-day mortality, multiple organ failure, intestinal ischemia, mesenteric vasoconstriction
- MeSH terms
- Humans, Prospective Studies, Retrospective Studies, Shock, Vasodilation, Mesenteric Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
