Materiały źródłowe

• #1 Prognostic Factors for Mortality in Acute Mesenteric Ischemia

  https://www.mdpi.com/2077-0383/11/13/3619

  Prognostic Factors for Mortality in Acute Mesenteric Ischemia […] Postoperative mortality in patients undergoing surgical and/or interventional treatment for acute mesenteric ischemia (AMI) has remained an unsolved problem in recent decades. […] Overall inhouse mortality was 55.9% (100/179). […] Multivariable analyses identified leukocytes (HR = 1.08; p = 0.008), lactate (HR = 1.25; p = 0.01), bilirubin (HR = 2.05; p = 0.045), creatinine (HR = 1.48; p = 0.039), etiology (AI, VI or NOMI; p = 0.038) and portomesenteric vein gas (PMVG; HR = 23.02; p = 0.012) as independent predictors of postoperative mortality. […] The clinical outcome of patients with AMI was determined using a combination of pre- and intraoperative clinical and radiological characteristics. Serum lactate appears to be of major clinical importance as the risk of fatal outcome increases significantly with higher lactate values. […] Despite a modern interdisciplinary treatment approach, the management and prevention of perioperative mortality are still challenging in AMI. […] By conducting multivariate analyses, we identified leucocytes, bilirubin, creatinine and lactate, the presence of PMVG, AI and the intraoperative application of FFP as the most important predictors of outcome in our cohort. […] The importance of lactate as a predictor of poor outcome was outlined. […] Our findings underline that physiological serum lactate concentrations cannot be used to rule out neither an AMI nor a fatal outcome completely but if elevated, serum lactate provides a broadly available and feasible predictive marker. […] We identified the degree of organ dysfunction (kidney and liver) and serum lactate, as well as radiological characteristics, of disease severity (PMVG), the underlying etiology (AI, NOMI) and intraoperative FFP administration to be of major importance for the prognosis of patients with AMI.

• #2 Prognostic factors of acute mesenteric ischemia in ICU patients | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-019-0999-8

  The primary endpoint was to investigate the prognostic factors of acute mesenteric ischemia (AMI) in ICU patients. […] The 30-day mortality rate was 71% for the 214 patients with arterial AMI. […] 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 24h of admission (OR=1.24; 95%CI=1.05-1.48; p=0.012) and anticoagulation (OR=0.19; 95%CI=0.04-0.84; p=0.029). [...] 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. [...] The 30-day mortality rate in the 214 included patients (51% men, mean age at diagnosis 72 years) was 71%, while in-hospital mortality was 68%.

• #3 Prognostic factors in patients with acute mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5508232/

  Acute mesenteric ischemia, one of the causes of acute abdominal pain due to occlusion of the superior mesenteric artery, has a fatal course as a result of intestinal necrosis. […] The mortality rate in AMI remains high due to challenges in early diagnosis, the lack of specific markers, and irreversible intestinal ischemia secondary to delay in diagnosis. […] Early diagnosis and commencing appropriate treatment is essential in AMI. A delay of twenty-four hours can decrease survival by 20%. […] The mean MPI score was 16.84.7 and 25.06 in Group 1 and Group 2, respectively, and the difference between the two groups was statistically significant (p0,001). […] The increased MPI score was significantly correlated with mortality (p=0.004). […] Suspicion of disease and early use of imaging in addition to clinical and laboratory evaluations are essential in order to decrease mortality rates in acute mesenteric ischemia. […] Prevention of complications with critical intensive care during the postoperative period aids in decreasing the mortality rate. In addition, using the Mannheim Peritonitis Index can be helpful.

• #4 Prognostic Factors for Mortality in Acute Mesenteric Ischemia

  https://ouci.dntb.gov.ua/en/works/7nNbJ2y7/

  Postoperative mortality in patients undergoing surgical and/or interventional treatment for acute mesenteric ischemia (AMI) has remained an unsolved problem in recent decades. […] Associations between postoperative mortality and various clinical variables were assessed using univariate and multivariable binary logistic regression analysis. […] Overall inhouse mortality was 55.9% (100/179). […] Multivariable analyses identified leukocytes (HR = 1.08; p = 0.008), lactate (HR = 1.25; p = 0.01), bilirubin (HR = 2.05; p = 0.045), creatinine (HR = 1.48; p = 0.039), etiology (AI, VI or NOMI; p = 0.038) and portomesenteric vein gas (PMVG; HR = 23.02; p = 0.012) as independent predictors of postoperative mortality. […] Further, the risk of fatal outcome changed disproportionally with increased preoperative lactate values. […] The clinical outcome of patients with AMI was determined using a combination of pre- and intraoperative clinical and radiological characteristics. […] Serum lactate appears to be of major clinical importance as the risk of fatal outcome increases significantly with higher lactate values.

• #5 Can Biomarkers be used for Prognosis Prediction in Patients with Acute Mesenteric Ischemia? – Istanbul Medical Journal

  https://istanbulmedicaljournal.org/articles/doi/imj.galenos.2023.73483

  Acute mesenteric ischemia (AMI) is a severe clinical condition that leads to intestinal ischemia and necrosis due to acute blockage of the mesenteric arteries. The mortality rate of AMI is still high, and early diagnosis and treatment are lifesaving. This study provides an overview of the biochemical parameters used to determine the prognosis of AMI patients. […] This study shows that the BUN/albumin ratio is a robust prognostic indicator of patients with AMI and guides clinicians decision-making. However, further studies are required to confirm these data. […] ROC analyses revealed that BUN/albumin, lactate/albumin, and CRP/albumin ratios are important prognostic indicators in patients with AMI. The AUC value for all three ratios (BUN/albumin especially) was statistically significant.

• #6 Can Biomarkers be used for Prognosis Prediction in Patients with Acute Mesenteric Ischemia? – Istanbul Medical Journal

  https://istanbulmedicaljournal.org/articles/doi/imj.galenos.2023.73483

  Our results indicated that the BUN/albumin ratio was the best predictor of determining this requirement. In addition, lactate/albumin and CRP/albumin values were also effective parameters for predicting patients. […] The findings of our study indicate that a CRP/albumin ratio of 0.17 may serve as a reliable predictor of postoperative problems. […] This study examined the BUN/albumin ratio as a prognostic indicator in critical care unit hospitalizations, revealing its significant predictive capacity. In comparison with the other ratios discussed, it was determined that the BUN/albumin number is the most practical measure.

• #7 The value of D-dimer and platelet-lymphocyte ratio combined with CT signs for predicting intestinal ischemia in patients with bowel obstruction | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0305163

  The combined use of D-dimer, PLR and CT signs has high diagnostic value for intestinal ischemia in patients with bowel obstruction and will prompt surgical exploration to evaluate intestinal blood flow. […] D-dimer, PLR, increased unenhanced bowel-wall attenuation, and mesenteric haziness are independent risk factors for intestinal ischemia in patients with bowel obstruction. […] The results showed that joint models had better diagnostic performance than single indicators in all cases. Specifically, the AUC, sensitivity, specificity, PPV, and NPV of the joint model III was 0.925 [95%CI: 0.8760.975], 79.2% [95%CI%: 67.291.1], 91.2% [95%CI: 83.798.9], 88.4% [95%CI: 78.498.4], and 83.9% [95%CI: 74.593.3], respectively. […] The multivariate analysis showed that D-dimer (OR = 2.450, 95%CI: [0.16265.359], p = 0.046), PLR (OR = 1.010, 95%CI: [1.0001.020], p = 0.044), increased unenhanced bowel-wall attenuation (OR = 20.003, 95%CI: [1.500266.745], p = 0.023) and mesenteric haziness (OR = 10.841, 95%CI: [2.32950.452], p = 0.002) were independent risk factors for intestinal ischemia in patients with bowel obstruction. […] Our study revealed that peritoneal irritation signs, D-dimer, lymphocyte values, PLR, NLR, and CT signs were strongly associated with intestinal ischemia in patients with bowel obstruction (all P0.05).

• #8 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5

  Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. […] The main issue for physicians regarding bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management, resulting in a poorer prognosis, especially after cardiac surgery. […] A biological scoring system based on PCT, ASAT, lactate, and myoglobin measurement allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and an early treatment in this high mortality disease. […] In the ischemia group, the postoperative mortality rate was 81.3% (n=39) vs. 7.3% (n=7) in the non-ischemia group.

• #9 Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0395-5

  The clinical interest of this score for the diagnosis of bowel ischemia may be attributed to its impact on the management of patients, especially those with a high risk of bowel ischemia after cardiovascular surgery; earlier CT scan and colonoscopies with a concomitant decrease in mortality due to a more aggressive management. […] Despite these shortcomings, the present study constitutes one of the largest available analyses of a patient population with bowel disorders and enables us to draw up hypotheses for future studies especially within the framework of a prospective evaluation as part of a series of exams to help in decision making.

• #10 Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9613727/

  Acute mesenteric ischemia (AMI) is a devastating disease with poor prognosis. Due to the multitude of underlying factors, prediction of outcomes remains poor. […] We aimed to identify factors governing diagnosis and survival in AMI and develop novel prognostic tools. […] As AMI remains a condition with high mortality, we identified factors predicting occurrence of IN with suspected AMI and survival when undergoing surgery for IN. […] We provide two new tools, which combine these parameters and might prove helpful in treatment of patients with AMI. […] The primary end point of the study was the assessment of survival rates of patients undergoing surgery for confirmed AMI/IN. […] The aim of the study was the identification of above-mentioned risk factors to provide surgeons and radiologists with prognostic tools to aid in outcome stratification for patients with AMI.

• #11 Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9613727/

  Our nomograms based on an extensive retrospective patient dataset combining clinical signs and symptoms, biochemical laboratory parameters and radiological findings, allow identification of patients at risk for IN or death upon undergoing surgery. […] The first nomogram enables the identification of patients with a high probability of underlying ischemia and need for acute surgical exploration. […] The estimation of survival at time of index surgery is enabled by use of our second nomogram, which includes decreased pH, increased creatinine, radiological atherosclerosis, vascular occlusion (versus non-occlusive MI) and involvement of the colon. […] We identified factors predicting occurrence of IN, namely increasing age and ASA score, PI, and bowel distension. Parameters affecting survival when undergoing surgery for AMI include colonic involvement, vascular occlusion, atherosclerosis, increasing creatinine and decreasing pH. […] Lastly, we provide two valuable new tools, which combine those parameters and might prove helpful to predict occurrence of IN and survival outcomes after surgery in patients with AMI and can easily be incorporated into daily practice.

• #12

  https://link.springer.com/article/10.1007/s00464-022-09673-1

  Acute mesenteric ischemia (AMI) is a devastating disease with poor prognosis. Due to the multitude of underlying factors, prediction of outcomes remains poor. […] We identified factors predicting occurrence of IN with suspected AMI and survival when undergoing surgery for IN. […] The first nomogram enables the identification of patients with a high probability of underlying ischemia and need for acute surgical exploration. The factors relevant for prediction of IN are increasing age and ASA score as well as radiological signs of PI and bowel distension. The estimation of survival at time of index surgery is enabled by use of our second nomogram, which includes decreased pH, increased creatinine, radiological atherosclerosis, vascular occlusion (versus non-occlusive MI) and involvement of the colon. […] We provide two valuable new tools, which combine those parameters and might prove helpful to predict occurrence of IN and survival outcomes after surgery in patients with AMI and can easily be incorporated into daily practice.

• #13 Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01339-9

  Reperfusion injury of the bowel occurred in 44% of patients with acute mesenteric ischemia treated by endovascular revascularization. […] A decreased bowel enhancement on initial CT (HR=8.2), an occlusion of the superior mesenteric artery (HR=7.0), an embolic cause (HR=7.4), and higher initial serum lactate level (HR=1.4) were identified as predictors of reperfusion injury. […] The three-month survival rate of the cohort was 76%, with 12 deaths (all in-hospital), with no difference according to the occurrence of RI (22/28 vs. 16/22; log rank=0.73). […] Despite a substantial amount of preclinical data assessing the biological or pathological process of bowel RI, no clinical studies have been performed to date. […] RI did not negatively influence patients short-term survival. However, the rate of secondary bowel resection was higher in patients with RI.

• #14 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Severe abdominal pain out of proportion to physical examination findings should be assumed to be AMI until disproven. (Recommendation 1B) […] The key to early diagnosis is a high level of clinical suspicion. […] Prompt diagnostic and intervention are essential to reduce the high mortality rates (50 to 80%). […] Intestinal viability is the most important factor influencing outcome in patients with AMI. Non-viable intestine, if unrecognized, results in multi-system organ dysfunction and ultimately death. […] The finding of massive gut necrosis requires careful assessment of the patients underlying co-morbidities and advanced directives in order to judge whether comfort carries the best treatment. (Recommendation 1C) […] The goal of surgical intervention for AMI includes: 1) Re-establishment blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel.

• #15 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Damage control surgery is an important adjunct for patients who require intestinal resection due to the necessity to reassess bowel viability and in patients with refractory sepsis. Planned re-laparotomy is an essential part of AMI management. (Recommendation 1B) […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. Electrolyte abnormalities should be corrected, and nasogastric decompression initiated. (Recommendation 1B) […] Broad-spectrum antibiotics should be administered immediately. Unless contraindicated, patients should be anticoagulated with intravenous unfractionated heparin. (Recommendation 1B) […] Computed tomography angiography (CTA) should be performed as soon as possible for any patient with suspicion for AMI. (Recommendation 1A)

• #16 Intestinal ischemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/symptoms-causes/syc-20373946

  Intestinal ischemia (is-KEE-me-uh) refers to a range of conditions that happen when blood flow to the intestines slows or stops. […] In severe cases, loss of blood flow to the intestines can cause lifelong damage to the intestines. And it may lead to death. […] Getting medical help early improves the chances of recovery. […] Acute mesenteric ischemia is the result of a sudden loss of blood flow to the small intestine. It may be due to: A blood clot, also called an embolus, that comes loose in the heart and travels through the blood to block an artery. […] Chronic mesenteric ischemia is due to the buildup of fatty deposits on an artery wall, called atherosclerosis. […] A possible dangerous complication of chronic mesenteric ischemia is having a blood clot within a narrowed artery. This can cause a sudden blockage, which can cause acute mesenteric ischemia. […] Complications of intestinal ischemia can include: Death of intestinal tissue. A sudden and complete blockage in blood flow to the intestines can kill intestinal tissue. This is called gangrene. […] Sometimes, intestinal ischemia can be fatal.

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