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Cited by 46Abdominal vascular conditions and treatmentsCOVID-19 Clinical Research StudiesRetinal and Optic Conditions

Acute mesenteric ischemia in COVID-19 patients

Open access
Serban, Dragos, Tribus, Laura Carina, Vancea, Geta, Stoian, Anca Pantea, Dascalu, Ana Maria, Suceveanu, Andra Iulia, Tanasescu, Ciprian, Costea, Andreea Cristina +5 more·2021·Journal of Clinical Medicine
DOI 10.3390/jcm11010200PMC PMC8745985
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Abstract

Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

AI snapshot

Written from the paper’s full text.

TL;DR

This review of 36 articles reporting 89 COVID-19 patients with acute mesenteric ischemia found distinct patterns by hospitalization status: ICU/hospitalized cases often had large bowel ischemia with microvascular thrombosis and high mortality, while non-hospitalized cases often had small bowel involvement with splanchnic thromboembolism and better outcomes. Age over 60 years and need for surgery were associated with the worst prognosis.

Key findings

  • Among 89 patients, 63 (70.7%) were hospitalized at onset; mortality was 54.4% in the hospitalized group vs. 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and need for surgery (p = 0.019) were associated with worst outcome.
  • In ICU patients, the large bowel alone was affected in 56% and large plus small bowel in 24%, with microvascular thrombosis; surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic vein or artery thromboembolism, and favorable response to conservative anticoagulant therapy was reported in 38.4%.
  • Elevated D-dimers, leukocytosis, and CRP were present in most reported cases; contrast-enhanced CT confirmed vascular thromboembolism and provided information on bowel viability. Venous thrombosis affecting the superior mesenteric vein and/or portal vein occurred in 40.9% of non-hospitalized cases and in only one hospitalized case.
  • Lactate was >2 mmol/L in 5 of 9 reported cases (55%); LDH was elevated in all 6 cases where determined, with mean 594 ± 305 U/L; ferritin was raised in 7 of 9 cases, ranging from 456 to 1570 ng/mL. Favorable results were obtained in 7 of 9 cases (77%) of splanchnic vein thrombosis and 2 of 7 cases (28.5%) with superior mesenteric artery thrombosis.

Methods

  • Comprehensive search of PubMed and Web of Science using terms “COVID-19” AND (“bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”); included English original papers and case reports with obtainable full text published until November 2021; excluded meeting abstracts, commentaries, and book chapters; hand-searched references of relevant reviews.
  • After duplication removal, 36 articles were included, reporting 89 patients: 6 retrospective studies documenting 55 ICU patients with COVID-19 pneumonia requiring surgical consult, and 30 case reports/series presenting 34 cases. Data extraction was independently completed by two researchers using PRISMA guidelines; statistical analysis with SciStat compared non-hospitalized vs. hospitalized patients and analyzed risk factors for adverse vital prognosis.
  • COVID-19 diagnosis was by PCR in all cases. Exclusions included papers without sufficient data on admission evaluation, SARS-CoV-2 documentation, or treatment, and patients with other conditions potentially complicating intestinal ischemia such as liver cirrhosis, hepatocellular carcinoma, intraabdominal infection, pancreatitis, and celiac disease.

Limitations

  • Stated: the review was not registered in PROSPERO; sample size was small, most studies were case reports or case series, which may be a significant source of bias; reported clinical and laboratory data differed across studies, so studies were compared only qualitatively.
  • Stated: due to the low number of cases in which lactate, LDH, and ferritin were reported, no statistical association could be performed with severity of lesions or adverse outcomes; there was no information regarding comorbidities in the retrospective studies included.
  • Evident: the evidence base is observational and heterogeneous, relying largely on case reports/series and retrospective cohorts, with no prospective controlled data; incidence estimates varied widely (0.22–10.5% in ICU patients) and the paper notes that incidence may be underestimated.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/jcm11010200

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 112 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the non-hospitalized group, a favorable response to conservative anticoagulant therapy was reported in 38.4%.

    “a favorable response to conservative anticoagulant therapy was reported in 38.4%”
    Quote in the paperNot a substantial claim
  • Findingown data

    63 of the 89 patients were hospitalized at the moment of onset.

    “63 being hospitalized at the moment of onset”
    • Also stated in: § 3.1. Risk Factors of Intestinal Ischemia in COVID-19 Patients · plain
      “Out of a total of 89 patients included in the review, 63 (70.7%) were hospitalized for severe forms of COVID-19 pneumonia at the moment of onset.”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients.

    “There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients”
    Quote in the paperSubstantial claim
  • Findingown data

    30 case reports or case series presented 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings.

    “We also identified 30 case reports or case series [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51] presenting 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings.”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [22] Azouz, 2020, Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19, Intensive Care Med. source

      Not checked in the free run.

    • cites [23] Stephen, 2021, Our early experience with mesenteric ischemia in COVID-19 positive patients, Ann. Vasc. Surg.

      Not checked in the free run.

    • cites [24] Ucpinar, 2020, Superior Mesenteric Artery Thrombosis in a Patient with COVID-19: A Unique Presentation, J. Coll Physicians Surg. Pak. source

      Not checked in the free run.

    • cites [25] Karna, 2020, Superior Mesenteric Artery Thrombosis in COVID-19 Pneumonia: An Underestimated Diagnosis—First Case Report in Asia, Indian J. Surg. source

      Not checked in the free run.

    • cites [26] Abeysekera, 2020, Spontaneous portomesenteric thrombosis in a non-cirrhotic patient with SARS-CoV-2 infection, BMJ Case Rep. source

      Not checked in the free run.

    • cites [27] 2020, Acute mesenteric thrombosis in two patients with COVID-19. Two cases report and literature review, Int. J. Surg. Case Rep. source

      Not checked in the free run.

    • cites [28] Dinoto, 2021, Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report, Int. J. Surg. Case Rep. source

      Not checked in the free run.

    • cites [29] Kiwango, 2021, Intestinal ischemia in a COVID-19 patient: Case report from Northern Tanzania, J. Surg. Case Rep. source

      Not checked in the free run.

    • cites [30] Sevella, 2021, Acute Mesenteric Ischemia as an Early Complication of COVID-19, Cureus

      Not checked in the free run.

    • cites [31] Nasseh, 2021, COVID-19 and gastrointestinal symptoms: A case report of a Mesenteric Large vessel obstruction, Clin. Case Rep. source

      Not checked in the free run.

  • Findingown data

    Age over 60 years (p = 0.043) was associated with the worst outcome.

    “Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome.”
    • Also stated in: § 3.4. Management and Outcomes · plain
      “We found that age over 60 years and the necessity of surgical treatment are statistically correlated with a poor outcome in the reviewed studies (Table 6).”
    Quote in the paperSubstantial claim
  • May combine two claims. 55
  • Classified as probably not a substantial claim. 32
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    After duplication removal, 36 articles were included, reporting data on 89 patients.

    “After duplication removal, a total of 36 articles were included in the review, reporting data on a total of 89 patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001).

    “Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    A contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability.

    “a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Elevated D-dimers, leukocytosis, and C reactive protein were present in most reported cases.

    “Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Despite early surgery, the outcome is severe in these cases, with an overall mortality of 45-50% in reported studies and up to 100% in patients over 65 years of age according to Hwabejira et al.

    “Despite early surgery, the outcome is severe in these cases, with an overall mortality of 45–50% in reported studies and up to 100% in patients over 65 years of age according to Hwabejira et al. [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Hwabejire, 2021, Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience, Am. Surg. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Physical exam evidenced abdominal distension, reduced bowel sounds, and tenderness at palpation.

    “Physical exam evidenced abdominal distension, reduced bowel sounds, and tenderness at palpation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    No readmissions were reported.

    “No readmissions were reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There is a slight male to female predominance (M:F = 1:68).

    “There is a slight male to female predominance (M:F = 1:68).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The mean age was 56.9 years.

    “The mean age was 56.9 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Serum ferritin was raised in 7 out of 9 reported cases, with values ranging from 456 to 1570 ng/mL.

    “In the reviewed studies, serum ferritin was raised in 7 out of 9 reported cases, with values ranging from 456 to 1570 ng/mL.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In ICU patients, CT exam showed in most cases permeable mesenteric vessels and diffuse intestinal ischemia affecting the large bowel alone (56%) or in association with the small bowel (24%).

    “In ICU patients, CT exam showed in most cases permeable mesenteric vessels and diffuse intestinal ischemia affecting the large bowel alone (56%) or in association with the small bowel (24%)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Radiological findings in the early stages included dilated intestinal loops, thickening of the intestinal wall, mesenteric fat edema, and air-fluid levels.

    “Radiological findings in the early stages included dilated intestinal loops, thickening of the intestinal wall, mesenteric fat edema, and air-fluid levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no significant statistical correlation between either the leukocyte count (p = 0.803) or D-dimers (p = 0.08) and the outcome.

    “However, there was no significant statistical correlation between either the leukocyte count (p = 0.803) or D-dimers (p = 0.08) and the outcome.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Several authors described in acute bowel ischemia encountered in ICU patients with COVID-19 a distinct yellowish color, rather than the typical purple or black color of ischemic bowel, predominantly located at the antimesenteric side or circumferentially with affected areas well delineated from the adjacent healthy areas.

    “Several authors described in acute bowel ischemia encountered in ICU patients with COVID-19, a distinct yellowish color, rather than the typical purple or black color of ischemic bowel, predominantly located at the antimesenteric side or circumferentially with affected areas well delineated from the adjacent healthy areas [18,19].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Yang, 2021, Colon ischemia in patients with severe COVID-19: A single-center retrospective cohort study of 20 patients, Int. J. Colorectal Dis. source

      Not checked in the free run.

    • cites [19] Hwabejire, 2021, Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience, Am. Surg. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In these cases, patency of large mesenteric vessels was confirmed, and the histopathological reports showed endothelitis, inflammation, and microvascular thrombosis in the submucosa or transmural.

    “In these cases, patency of large mesenteric vessels was confirmed, and the histopathological reports showed endothelitis, inflammation, and microvascular thrombosis in the submucosa or transmural.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    LDH was determined in 6 cases, and it was found to be elevated in all cases, with a mean value of 594+/−305 U/L.

    “LDH was determined in 6 cases, and it was found to be elevated in all cases, with a mean value of 594+/−305 U/L.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Favorable results were obtained in 7 out of 9 cases (77%) of splanchnic veins thrombosis and in 2 of 7 cases (28.5%) with superior mesenteric artery thrombosis.

    “Favorable results were obtained in 7 out of 9 cases (77%) of splanchnic veins thrombosis and in 2 of 7 cases (28.5%) with superior mesenteric artery thrombosis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Venous thrombosis affecting the superior mesenteric vein and or portal vein was encountered in 40.9% of reported cases of non-hospitalized COVID-19 patients, and in only one case in the hospitalized group.

    “Venous thrombosis affecting the superior mesenteric vein and or portal vein was encountered in 40.9% of reported cases of non-hospitalized COVID-19 patients, and in only one case in the hospitalized group (Table 5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Obesity might be considered a possible risk factor, with a reported mean BMI of 31.2-32.5 in hospitalized patients.

    “Obesity might be considered a possible risk factor, with a reported mean BMI of 31.2–32.5 in hospitalized patients [16,18,19].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] Kaafarani, 2020, Gastrointestinal Complications in Critically Ill Patients With COVID-19, Ann. Surg. source

      Not checked in the free run.

    • cites [18] Yang, 2021, Colon ischemia in patients with severe COVID-19: A single-center retrospective cohort study of 20 patients, Int. J. Colorectal Dis. source

      Not checked in the free run.

    • cites [19] Hwabejire, 2021, Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience, Am. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The location and extent of venous or arterial thrombosis were determined by contrast-enhanced abdominal CT, which also provided important information on the viability of the intestinal segment whose vascularity was affected.

    “The location and extent of venous or arterial thrombosis were determined by contrast-enhanced abdominal CT, which also provided important information on the viability of the intestinal segment whose vascularity was affected.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Once the viability of the affected intestinal segment is compromised, a CT exam may evidence pneumatosis as a sign of bacterial proliferation and translocation in the intestinal wall, pneumoperitoneum due to perforation, and free fluid in the abdominal cavity.

    “Once the viability of the affected intestinal segment is compromised, a CT exam may evidence pneumatosis as a sign of bacterial proliferation and translocation in the intestinal wall, pneumoperitoneum due to perforation, and free fluid in the abdominal cavity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The hospitalized patients were receiving anticoagulant medication when reported, consisting of low molecular weight heparin at prophylactic doses.

    “These patients were receiving anticoagulant medication when reported, consisting of low molecular weight heparin (LMWH) at prophylactic doses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 26 cases, the acute ischemic event appeared as the first symptom of COVID-19 disease, or in mild forms treated at home, or after discharge for COVID-19 pneumonia and cessation of the anticoagulant medication.

    “In 26 cases, the acute ischemic event appeared as the first symptom of COVID-19 disease, or in mild forms treated at home, or after discharge for COVID -19 pneumonia and cessation of the anticoagulant medication (Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Diabetes mellitus and hypertension were the most frequent comorbidities encountered in case reports (8 in 34 patients, 23%), and 7 out of 8 patients presented both.

    “Diabetes mellitus and hypertension were the most frequent comorbidities encountered in case reports (8 in 34 patients, 23%), and 7 out of 8 patients presented both (Table 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Abdominal pain was encountered in all cases, either generalized from the beginning, of high intensity, or firstly localized in the epigastrium or the mezogastric area.

    “Abdominal pain was encountered in all cases, either generalized from the beginning, of high intensity, or firstly localized in the epigastrium or the mezogastric area.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Thrombocytosis and thrombocytopenia have been reported in published cases with mesenteric ischemia.

    “Thrombocytosis and thrombocytopenia have been reported in published cases with mesenteric ischemia [30,35,42,46,50].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [30] Sevella, 2021, Acute Mesenteric Ischemia as an Early Complication of COVID-19, Cureus

      Not checked in the free run.

    • cites [35] Cheung, 2020, Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection, Am. J. Case Rep. source

      Not checked in the free run.

    • cites [42] Lari, 2020, Severe ischemic complications in COVID-19-a case series, Int. J. Surg. Case Rep. source

      Not checked in the free run.

    • cites [46] Goodfellow, 2021, Mesenteric Venous Thrombosis Due to Coronavirus in a Post Roux-en-Y Gastric Bypass Patient: A Case Report, Obes. Surg. source

      Not checked in the free run.

    • cites [50] Singh, 2020, Acute Intestinal Ischemia in a Patient with COVID-19 Infection, Korean J. Gastroenterol. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Lactate levels were reported in 9 cases, with values higher than 2 mmol/L in 5 cases (55%).

    “Lactate levels were reported in 9 cases, with values higher than 2 mmol/L in 5 cases (55%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In COVID-19 patients non hospitalized at the onset of an acute ischemic event, with mild and moderate forms of the disease, the outcome was less severe, with recovery in 77% of cases.

    “In COVID-19 patients non hospitalized at the onset of an acute ischemic event, with mild and moderate forms of the disease, the outcome was less severe, with recovery in 77% of cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    According to the type of mesenteric ischemia, venous thrombosis was more likely to have a favorable outcome (recovery in 80% of cases), while vascular microthrombosis led to death in 66% of cases.

    “According to the type of mesenteric ischemia, the venous thrombosis was more likely to have a favorable outcome (recovery in 80% of cases), while vascular micro thombosis lead to death in 66% of cases.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Disturbance of lung-gut axis, prolonged hospitalization in ICU, and the procoagulation state induced by SARS-CoV-2 endothelial damage was incriminated for bowel ischemia, resulting in intestinal necrosis and perforation.

    “On the other hand, disturbance of lung-gut axis, prolonged hospitalization in ICU, and the pro coagulation state induced by SARS-CoV-2 endothelial damage was incriminated for bowel ischemia, resulting in intestinal necrosis and perforation [8,9,15].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Guan, 2020, Clinical characteristics of coronavirus disease 2019 in China, N. Engl. J. Med. source

      Not checked in the free run.

    • cites [9] 2021, Severe bowel complications in SARS-CoV-2 patients receiving protocolized care, Rev. Gastroenterol. Mex. Engl. Ed.

      Not checked in the free run.

    • cites [15] Ludewig, S., Jarbouh, R., Ardelt, M., Mothes, H., Rauchfuß, F., Fahrner, R., Zanow, J., and Settmacher, U. (2017). Bowel Ischemia in ICU Patients: Diagnostic Value of I-FABP Depends on the Interval to the Triggering Event. Gastroenterol. Res. Pract., 2795176. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A PRISMA flowchart was employed to screen papers for eligibility and a PRISMA checklist is presented.

    “A PRISMA flowchart was employed to screen papers for eligibility (Figure 1) and a PRISMA checklist is presented as a Supplementary File S1.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Any disagreement was solved by discussion.

    “Any disagreement was solved by discussion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    COVID-19 is known to cause significant alteration of coagulation, causing thromboembolic acute events, of which the most documented were pulmonary embolism, acute myocardial infarction, and lower limb ischemia.

    “COVID-19 is known to cause significant alteration of coagulation, causing thromboembolic acute events, of which the most documented were pulmonary embolism, acute myocardial infarction, and lower limb ischemia [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Moradi, 2021, Post COVID-19 splenic infarction with limb ischemia: A case report, Ann. Med. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In non-COVID patients, the etiology of AMI may be mesenteric arterial embolism (50%), mesenteric arterial thrombosis (15-25%), venous thrombosis (5-15%), or non-occlusive causes associated with low blood flow.

    “In non-COVID patients, the etiology may be mesenteric arterial embolism (in 50%), mesenteric arterial thrombosis (15–25%), venous thrombosis (5–15%), or less frequent, from non-occlusive causes associated with low blood flow [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Bala, 2017, Acute mesenteric ischemia: Guidelines of the World Society of Emergency Surgery, World J. Emerg. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Gastrointestinal features in COVID-19 disease are relatively frequently reported, varying from less than 10% in early studies from China to 30-60% in other reports.

    “Gastrointestinal features in COVID-19 disease are relatively frequently reported, varying from less than 10% in early studies from China [7,8] to 30–60%, in other reports [9,10].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [7] Elmunzer, 2021, North American Alliance for the Study of Digestive Manifestations of COVID-19. Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019, Clin. Gastroenterol. Hepatol. source

      Not checked in the free run.

    • cites [8] Guan, 2020, Clinical characteristics of coronavirus disease 2019 in China, N. Engl. J. Med. source

      Not checked in the free run.

    • cites [9] 2021, Severe bowel complications in SARS-CoV-2 patients receiving protocolized care, Rev. Gastroenterol. Mex. Engl. Ed.

      Not checked in the free run.

    • cites [10] Redd, 2020, Prevalence and characteristics of gastrointestinal symptoms in patients with SARS-CoV-2 infection in the United States: A multicenter cohort study, Gastroenterology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a study by Xu et al., rectal swabs were positive in 8 of 10 pediatric patients, even after the nasopharyngeal swabs became negative.

    “In a study by Xu et al., rectal swabs were positive in 8 of 10 pediatric patients, even after the nasopharyngeal swabs became negative [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Xu, 2020, Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding, Nat. Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A data extraction sheet was independently completed by two researchers, with strict adherence to PRISMA guidelines.

    “A data extraction sheet was independently completed by two researchers, with strict adherence to PRISMA guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Portal vein thrombosis and mesenteric vein thrombosis can be seen with celiac disease, appendicitis, pancreatitis, and liver cirrhosis and hepatocellular cancer.

    “Portal vein thrombosis and mesenteric vein thrombosis can be seen with celiac disease [2], appendicitis [3], pancreatitis [4], and, in particular, liver cirrhosis and hepatocellular cancer [5].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Dumic, 2017, Deep Venous Thrombosis and Bilateral Pulmonary Embolism Revealing Silent Celiac Disease: Case Report and Review of the Literature, Case Rep. Gastrointest. Med.

      Not checked in the free run.

    • cites [3] Akhrass, 2015, Gastrointestinal variant of Lemierre’s syndrome complicating ruptured appendicitis, IDCases source

      Not checked in the free run.

    • cites [4] Radovanovic, 2020, Fusobacterium necrophorum subsp. necrophorum Liver Abscess with Pylephlebitis: An Abdominal Variant of Lemierre’s Syndrome, Case Rep. Infect. Dis.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In an extensive study on 1992 hospitalized patients for COVID-19 pneumonia from 36 centers, Elmunzer et al. found that the most frequent clinical signs reported were mild and self-limited in up to 74% of cases, consisting of diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%).

    “In an extensive study on 1992 hospitalized patients for COVID-19 pneumonia from 36 centers, Elmunzer et al. [7] found that the most frequent clinical signs reported were mild and self-limited in up to 74% of cases, consisting of diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Elmunzer, 2021, North American Alliance for the Study of Digestive Manifestations of COVID-19. Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019, Clin. Gastroenterol. Hepatol. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The sample size was small, most studies being case reports or case series, which may be a significant source of bias.

    “The sample size was small, most of them being case reports or case series, which may be a significant source of bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    ACE2 receptors are present at the level of the intestinal wall, and enterocytes may be directly infected by SARS-CoV-2.

    “ACE2 receptors are present at the level of the intestinal wall, and enterocytes may be directly infected by SARS-CoV-2.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [4] Radovanovic, 2020, Fusobacterium necrophorum subsp. necrophorum Liver Abscess with Pylephlebitis: An Abdominal Variant of Lemierre’s Syndrome, Case Rep. Infect. Dis.

      Not checked in the free run.

    • cites [11] Hajifathalian, 2020, Gastrointestinal and hepatic manifestations of 2019 novel coronavirus disease in a large cohort of infected patients from New York: Clinical implications, Gastroenterology source

      Not checked in the free run.

    • cites [12] Kotfis, 2020, COVID-19: Gastrointestinal symptoms and potential sources of SARS-CoV-2 transmission, Anaesthesiol. Intensive Ther. source

      Not checked in the free run.

    • cites [13] Xiao, 2020, Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    COVID-19 diagnosis was made by PCR assay in all cases.

    “COVID-19 diagnosis was made by PCR assay in all cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a study by Kaafarani et al., up to half of the patients with gastrointestinal features presented some degrees of intestinal hypomotility, possibly due to direct viral invasion of the enterocytes and neuro-enteral disturbances.

    “In a study by Kaafarani et al., up to half of the patients with gastrointestinal features presented some degrees of intestinal hypomotility, possibly due to direct viral invasion of the enterocytes and neuro-enteral disturbances [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Kaafarani, 2020, Gastrointestinal Complications in Critically Ill Patients With COVID-19, Ann. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Leucocyte count may be within normal values in case of early presentation.

    “Leucocyte count may be within normal values in case of early presentation [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Randhawa, 2021, Thrombosis of the Portal Vein and Superior Mesenteric Vein in a Patient With Subclinical COVID-19 Infection, Cureus

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study by O'Shea et al., 26% of hospitalized patients for COVID-19 pneumonia who underwent imagistic examination presented results positive for coagulopathy, and in 22% of these cases, the thromboembolic events were with multiple locations.

    “In a study by O’Shea et al. [20], 26% of hospitalized patients for COVID-19 pneumonia who underwent imagistic examination, presented results positive for coagulopathy, and in 22% of these cases, the thromboembolic events were with multiple locations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Parakh, 2021, Multisystem assessment of the imaging manifestations of coagulopathy in hospitalized patients with coronavirus, Am. J. Roentgenol. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    One explanation for the higher venous thrombosis in non-hospitalized patients may be the beneficial role of thrombotic prophylaxis in preventing venous thrombosis in COVID-19 patients, which is routinely administrated in hospitalized cases, but not reported in cases treated at home with COVID-19 pneumonia.

    “One explanation may be the beneficial role of thrombotic prophylaxis in preventing venous thrombosis in COVID-19 patients, which is routinely administrated in hospitalized cases, but not reported in cases treated at home with COVID-19 pneumonia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ferritin levels were found to be correlated also with the severity of pulmonary lesions in COVID-19 patients.

    “However, ferritin levels were found to be correlated also with the severity of pulmonary lesions in COVID-19 patients [52].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Carubbi, 2021, Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: Data from two Italian COVID-19 units, Sci. Rep. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    In cases with an unconfirmed diagnosis of COVID-19, examination of the pulmonary basis during abdominal CT exam can add consistent findings to establish the diagnosis.

    “In cases with an unconfirmed diagnosis of COVID-19, examination of the pulmonary basis during abdominal CT exam can add consistent findings to establish the diagnosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In cases of portal vein thrombosis, the initial location may be in the right hypochondrium, mimicking biliary colic.

    “In cases of portal vein thrombosis, the initial location may be in the right hypochondrium, mimicking biliary colic [26,34].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Abeysekera, 2020, Spontaneous portomesenteric thrombosis in a non-cirrhotic patient with SARS-CoV-2 infection, BMJ Case Rep. source

      Not checked in the free run.

    • cites [34] Randhawa, 2021, Thrombosis of the Portal Vein and Superior Mesenteric Vein in a Patient With Subclinical COVID-19 Infection, Cureus

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The association between obesity and acute intestinal ischemia should be regarded with caution, since obesity is also a risk factor for severe forms of COVID-19.

    “However, this association should be regarded with caution, since obesity is also a risk factor for severe forms of COVID-19.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    D-dimer is a highly sensitive investigation for the prothrombotic state caused by COVID-19 and, when reported, was found to be above the normal values.

    “D-dimer is a highly sensitive investigation for the prothrombotic state caused by COVID-19 [45] and, when reported, was found to be above the normal values.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Amaravathi, 2021, Superior Mesenteric Arterial and Venous Thrombosis in COVID-19, J. Emerg. Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The pattern of diffuse intestinal ischemia in ICU patients suggests pathogenic mechanisms, direct viral infection, small vessel thrombosis, or 'nonocclusive mesenteric ischemia'.

    “suggesting pathogenic mechanisms, direct viral infection, small vessel thrombosis, or “nonocclusive mesenteric ischemia” [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Kaafarani, 2020, Gastrointestinal Complications in Critically Ill Patients With COVID-19, Ann. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Abdominal pain, out of proportion to physical findings, is a hallmark of porto-mesenteric thrombosis, typically associated with fever and leukocytosis.

    “Abdominal pain, out of proportion to physical findings, is a hallmark of porto-mesenteric thrombosis, typically associated with fever and leukocytosis [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Radovanovic, 2020, Fusobacterium necrophorum subsp. necrophorum Liver Abscess with Pylephlebitis: An Abdominal Variant of Lemierre’s Syndrome, Case Rep. Infect. Dis.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Guarding may be evocative for peritonitis due to compromised vascularization of bowel loops and bacterial translocation or franc perforation.

    “Guarding may be evocative for peritonitis due to compromised vascularization of bowel loops and bacterial translocation or franc perforation [35,39].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [35] Cheung, 2020, Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection, Am. J. Case Rep. source

      Not checked in the free run.

    • cites [39] Romero, 2021, Acute mesenteric arterial thrombosis in severe SARS-Co-2 patient: A case report and literature review, Int. J. Surg. Case Rep. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several clinical studies found that LDH is a useful biomarker for acute mesenteric ischemia.

    “Several clinical studies found that LDH is a useful biomarker for acute mesenteric ischemia, [55,56].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55] Matsumoto, 2014, Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia, Br. J. Surg. source

      Not checked in the free run.

    • cites [56] Soni, 2017, Role of serum lactic dehydrogenase, glutamic oxaloacetic transaminase, creatine phosphokinase, alkaline phospatase, serum phosphorus in the cases of bowel Ischaemia in acute abdomen, Int. Surg. J. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cases of acute cholecystitis, splenic infarction, or acute pancreatitis have also been reported in patients infected with SARS-CoV-2, with microvascular lesions as a pathophysiological mechanism.

    “Cases of acute cholecystitis, splenic infarction, or acute pancreatitis have also been reported in patients infected with SARS-CoV-2, with microvascular lesions as a pathophysiological mechanism [63].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Serban, 2021, Acute surgical abdomen during the COVID 19 pandemic: Clinical and therapeutic challenges, Exp. Ther. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Acute embolism in small vessels may be caused by direct viral invasion via ACE-2 receptors, resulting in endothelitis and inflammation, recruiting immune cells, and expressing high levels of pro-inflammatory cytokines, such as IL-6 and TNF-alfa, with consequent apoptosis of endothelial cells.

    “Acute embolism in small vessels may be caused by the direct viral invasion, via ACE-2 Receptors, resulting in endothelitis and inflammation, recruiting immune cells, and expressing high levels of pro-inflammatory cytokines, such as Il-6 and TNF-alfa, with consequently apoptosis of the endothelial cells [69].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Varga, 2020, Endothelial cell infection and endotheliitis in COVID-19, Lancet source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    Viral binding to ACE2 receptors leads to significant changes in fluid-coagulation balance, including increased IL6 levels, cytokine storm, expression of tissue inhibitor of plasminogen-1 and tissue factor, and triggering of the coagulation system through binding to clotting factor VIIa.

    “Viral binding to ACE2Receptors leads to significant changes in fluid-coagulation balance: reduction in Ang 2 degradation leads to increased Il6 levels, and the onset of storm cytokines, such as IL-2, IL-7, IL-10, granulocyte colony-stimulating factor, IgG -induced protein 10, monocyte chemoattractant protein-1, macrophage inflammatory protein 1-alpha, and tumor necrosis factor α [67], but also in”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [67] Huang, 2020, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Lancet source

      Not checked in the free run.

    • cites [68] Avila, 2021, Thrombotic complications of COVID-19, Am. J. Emerg. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the study of O'Shea et al., on 146 COVID-19 hospitalized patients that underwent CT-scan, vascular thrombosis was identified in 26% of cases, the most frequent location being in lungs.

    “In the study of O’Shea et al., on 146 COVID-19 hospitalized patients that underwent CT-scan, vascular thrombosis was identified in 26% of cases, the most frequent location being in lungs [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Parakh, 2021, Multisystem assessment of the imaging manifestations of coagulopathy in hospitalized patients with coronavirus, Am. J. Roentgenol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Interpretation of LDH results may be difficult in COVID-19 patients, as both lactate and LDH were also found to be independent risk factors of severe forms of COVID-19.

    “However, interpretation of the results may be difficult in COVID-19 patients, as both lactate and LDH were also found to be independent risk factors of severe forms of COVID-19 [57,58].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [57] Han, 2020, Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: A retrospective and observational study, Aging source

      Not checked in the free run.

    • cites [58] Carpenè, G., Onorato, D., Nocini, R., Fortunato, G., Rizk, J.G., Henry, B.M., and Lippi, G. (2021). Blood lactate concentration in COVID-19: A systematic literature review. Clin. Chem. Lab. Med., advance online publication. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Acute arterial obstruction of the small intestinal vessels and mesenteric ischemia may appear due to hypercoagulability associated with SARS-CoV-2 infection, mucosal ischemia, viral dissemination, and endothelial cell invasion via ACE-2 receptors.

    “Acute arterial obstruction of the small intestinal vessels and mesenteric ischemia may appear due to hypercoagulability associated with SARS-CoV-2 infection, mucosal ischemia, viral dissemination, and endothelial cell invasion vis ACE-2 receptors [65,66].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [65] Yantiss, 2021, Intestinal Abnormalities in Patients With SARS-CoV-2 Infection: Histopathologic Changes Reflect Mechanisms of Disease, Am. J. Surg. Pathol. source

      Not checked in the free run.

    • cites [66] McGonagle, 2021, COVID-19 vasculitis and novel vasculitis mimics, Lancet Rheumatol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Higher D-lactate levels could be more specific for mesenteric ischemia due to increased bacterial proliferation at the level of the ischemic bowel, but the results obtained in different studies are mostly inconsistent.

    “Higher D-lactate levels could be more specific for mesenteric ischemia due to increased bacterial proliferation at the level of the ischemic bowel, but the results obtained in different studies are mostly inconsistent [53,54].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] Isfordink, 2018, Clinical value of serum lactate measurement in diagnosing acute mesenteric ischaemia, Neth. J. Med.

      Not checked in the free run.

    • cites [54] Montagnana, 2018, Biochemical markers of acute intestinal ischemia: Possibilities and limitations, Ann. Transl. Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    The site of the ischemic process, embolism or thrombosis, may be in the micro vascularization, veins, or mesenteric arteries.

    “The site of the ischemic process, embolism or thrombosis, may be in the micro vascularization, veins, or mesenteric arteries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Heparin has an anticoagulant, anti-inflammatory, endothelial protective role in COVID-19, which can improve microcirculation and decrease possible ischemic events.

    “Heparin has an anticoagulant, anti-inflammatory, endothelial protective role in COVID-19, which can improve microcirculation and decrease possible ischemic events [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Karna, 2020, Superior Mesenteric Artery Thrombosis in COVID-19 Pneumonia: An Underestimated Diagnosis—First Case Report in Asia, Indian J. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Plotz et al. found a thrombotic vasculopathy with histological evidence for lectin pathway complement activation mirroring viral protein deposition in a patient with COVID-19 and SLE, suggesting this might be a potential mechanism in SARS-CoV-2 associated thrombotic disorders.

    “Plotz et al. found a thrombotic vasculopathy with histological evidence for lectin pathway complement activation mirroring viral protein deposition in a patient with COVID-19 and SLE, suggesting this might be a potential mechanism in SARS-CoV-2 associated thrombotic disorders [47].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Plotz, 2021, Focal small bowel thrombotic microvascular injury in COVID-19 mediated by the lectin complement pathway masquerading as lupus enteritis, Rheumatology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    If diagnosed early, intestinal ischemia is potentially reversible and can be treated conservatively.

    “If diagnosed early, the intestinal ischemia is potentially reversible and can be treated conservatively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The authors raised awareness about the possibility of underestimation of the incidence of thrombotic events in COVID-19 patients.

    “The authors raised awareness about the possibility of underestimation of the incidence of thrombotic events in COVID-19 patients [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Parakh, 2021, Multisystem assessment of the imaging manifestations of coagulopathy in hospitalized patients with coronavirus, Am. J. Roentgenol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Several pathophysiological mechanisms have been considered, and they can be grouped into occlusive and non-occlusive causes.

    “Several pathophysiological mechanisms have been considered, and they can be grouped into occlusive and non-occlusive causes [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Patel, 2021, Bowel ischaemia in COVID-19: A systematic review, Int. J. Clin. Pract. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Gastrointestinal ischemic lesions were identified in 4 cases, in multiple locations (pulmonary, hepatic, cerebellar parenchymal infarction) in 3 patients.

    “Gastrointestinal ischemic lesions were identified in 4 cases, in multiple locations (pulmonary, hepatic, cerebellar parenchymal infarction) in 3 patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Parakh, 2021, Multisystem assessment of the imaging manifestations of coagulopathy in hospitalized patients with coronavirus, Am. J. Roentgenol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Platelet activation, platelet-monocyte aggregation formation, and Neutrophil extracellular traps released from activated neutrophils were documented in severe COVID-19 patients by several studies.

    “Platelet activation, platelet–monocyte aggregation formation, and Neutrophil external traps (NETs) released from activated neutrophils, constitute a mixture of nucleic DNA, histones, and nucleosomes [59,72] were documented in severe COVID-19 patients by several studies [70,71,73].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [70] Maier, 2020, COVID-19-associated hyperviscosity: A link between inflammation and thrombophilia?, Lancet source

      Not checked in the free run.

    • cites [71] Miyara, 2021, Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York, Front. Med. source

      Not checked in the free run.

    • cites [73] Hottz, 2020, Platelet activation and platelet-monocyte aggregate formation trigger tissue factor expression in patients with severe COVID-19, Blood J. Am. Soc. Hematol.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    Understanding the pathological pathways and risk factors could help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

    “Understanding the pathological pathways and risk factors could help adjust the thromboprophylaxis and fluid management in COVID-19 patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    These findings may justify the recommendation for an IL-1 receptor antagonist (IL-1Ra) which can prevent hemodynamic changes, septic shock, organ inflammation, and vascular thrombosis in severe forms of COVID-19 patients.

    “These findings may justify the recommendation for an IL-1 receptor antagonist (IL-1Ra) which can prevent hemodynamic changes, septic shock, organ inflammation, and vascular thrombosis in severe forms of COVID-19 patients [80,81,82].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [80] Wang, 2021, COVID-19 and the digestive system: A comprehensive review, World J. Clin. Cases source

      Not checked in the free run.

    • cites [81] Manolis, 2021, COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management, J. Cardiovasc. Pharmacol. Ther. source

      Not checked in the free run.

    • cites [82] Conti, 2020, IL-1 induces throboxane-A2 (TxA2) in COVID-19 causing inflammation and micro-thrombi: Inhibitory effect of the IL-1 receptor antagonist (IL-1Ra), J. Biol. Regul. Homeost. Agents

      Not checked in the free run.

72 of 72

  • The paper relies on this without support.

    Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection.

    “Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection.”

  • The paper relies on this without support.

    The studies analyzed in the present review were comparable in terms of patient selection, methodology, therapeutic approach, and the report of final outcome.

    “The studies analyzed in the present review were comparable in terms of patient selection, methodology, therapeutic approach, and the report of final outcome.”

  • The paper relies on this without support.

    SARS-CoV-2 infection is associated with an increased risk of venous thrombosis and arterial thromboembolism.

    “Thromboprophylaxis is highly recommended in the absence of contraindications, due to the increased risk of venous thrombosis and arterial thromboembolism associated with SARS-CoV-2 infection, with dose adjustment based on weight and associated risk factors.”
3 of 3

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?

  • Various risk factors, including advanced age, hypertension, atrial fibrillation, cardiovascular disease, diabetes, dyslipidemia, obesity, and sleep apnea, have been linked to the development of acute mesenteric ischemia in COVID-19 patients.

    “Various risk factors, including advanced age, hypertension, atrial fibrillation, cardiovascular disease, diabetes, dyslipidemia, obesity, and sleep apnea, have been linked to the development of AMI in COVID-19 patients [10-12].”

    From Outcomes of Acute Mesenteric Ischemia in Patients With COVID-19: A Nationwide Database Study (2023) · cites this paper as [11]

    The Results (§3.1; page not provided) report hypertension and diabetes among COVID-19 patients with intestinal ischemia and describe obesity as a possible risk factor, while cautioning that its association is uncertain. The paper links age over 60 to worse outcomes, not to developing ischemia (§3.4), and identifies atrial fibrillation and cardiovascular conditions as AMI risks chiefly outside the COVID-19 setting (Introduction; §3.2). Our copy does not establish dyslipidemia or sleep apnea as risk factors. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • According to a literature review by Serban et al., advanced age and the need for surgery are significantly correlated with worse outcomes in acute mesenteric ischemia patients, with a mortality rate of 54.4% among hospitalized individuals compared to 21.7% in non-hospitalized COVID-19 patients with acute mesenteric ischemia.

    “According to a literature review by Serban et al., advanced age and the need for surgery are significantly correlated with worse outcomes in AMI patients, with a mortality rate of 54.4% among hospitalized individuals compared to 21.7% in non-hospitalized COVID-19 patients with AMI [11].”

    From Outcomes of Acute Mesenteric Ischemia in Patients With COVID-19: A Nationwide Database Study (2023) · cites this paper as [11]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Goodfellow case cites the wrong reference

    Minor

    The cited reference [25] is by Karna et al.; the Goodfellow report is listed as reference [46].

  • Stefely study cites the wrong reference

    Minor

    Reference [68] lists Avila et al., while the Stefely et al. study described here is reference [74].

  • Sex ratio contradicts stated male predominance

    Minor

    An M:F ratio of 1:68 indicates far more females than males, not a slight male predominance.

3 of 3

The citation lists haven’t been fetched yet

References 90 · Cited by 46

Authors
Serban, D., Tribus, L. C., Vancea, G., Stoian, A. P., Dascalu, A. M., Suceveanu, A. I., Tanasescu, C., Costea, A. C., Tudosie, M. S., Tudor, C., Gangura, G. A., Duta, L., & Costea, D. O.
Affiliations
  • Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
  • Carol Davila University of Medicine and Pharmacy (RO)
  • Ovidius University (RO)
  • Lucian Blaga University of Sibiu (RO)
  • Department of Nephrology, Diaverum Clinic Constanta, 900612 Constanta, Romania
  • Bucharest Emergency University Hospital (RO)
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2021-12-30
Volume
11
Issue
1
Pages
200
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm11010200
PMC
PMC8745985
OpenAlex
W4205223519
Cited by
46
References
90
Citations by year
2026: 2 · 2025: 2 · 2024: 4 · 2023: 23 · 2022: 15
FWCI
2.53
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Ophthalmology › Retinal and Optic Conditions
Keywords
acute mesenteric ischemia, COVID-19 pandemic, SARS-CoV-2, intestinal ischemia, mesenteric thrombosis, thromboembolism, D-dimer, contrast-enhanced CT, bowel viability, surgical management, anticoagulation, mortality, risk factors, thromboprophylaxis

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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