Materiały źródłowe

• #1

  https://www.ijsurgery.com/index.php/isj/article/view/747

  Background: Acute mesenteric ischemia (AMI) is defined as a sudden loss of blood supply to visceral tissue, and it potentially results in intestinal infarction. […] Mortality from AMI remains high despite an aggressive approach consisting of early diagnosis, restoration of arterial perfusion, resection of nonviable intestine, second-look laparotomy, and supportive intensive care with an average from published reports ranging from 30% to 65%. […] While major advances in the technology and availability of imaging modalities have made earlier diagnosis and treatment more feasible, this has been counterbalanced by the contemporary AMI patient presenting at an advanced age and with more severe underlying comorbidities. […] When SOFA score increased to greater than 13 all patients succumbed to the disease with a mortality of 100% in the groups with SOFA score 13-16 and 17-20.

• #2 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. […] Although significant advances in its diagnosis and treatment have been made over the last decade, mortality rates are still reported to be around 40-70% for acute mesenteric ischemia mainly due to a low index of suspicion. […] The mean MPI score was 16.8 ± 4.7 and 25.0 ± 6 in Group 1 and Group 2, respectively, and the difference between the two groups was statistically significant (p < 0.001). [...] The increased MPI score was significantly correlated with mortality (p = 0.004).

• #3 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.

• #4 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%.

• #5 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. […] 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. […] Serum lactate appears to be of major clinical importance as the risk of fatal outcome increases significantly with higher lactate values.

• #6

  https://www.ijsurgery.com/index.php/isj/article/view/747

  Background: Acute mesenteric ischemia (AMI) is defined as a sudden loss of blood supply to visceral tissue, and it potentially results in intestinal infarction. […] Mortality from AMI remains high despite an aggressive approach consisting of early diagnosis, restoration of arterial perfusion, resection of nonviable intestine, second-look laparotomy, and supportive intensive care with an average from published reports ranging from 30% to 65%. […] While major advances in the technology and availability of imaging modalities have made earlier diagnosis and treatment more feasible, this has been counterbalanced by the contemporary AMI patient presenting at an advanced age and with more severe underlying comorbidities. […] When SOFA score increased to greater than 13 all patients succumbed to the disease with a mortality of 100% in the groups with SOFA score 13-16 and 17-20.

• #7

  https://www.ijsurgery.com/index.php/isj/article/view/747

  When MOD score increased to greater than 12 all patients succumbed to the disease with a mortality of 100% in the groups with MOD score 13-16 and 17-20. […] On comparing the predictive outcome of SOFA vs MOD scoring system, both had similar results in predicting mortality (p value 0.0001). […] To conclude, both SOFA and MOD scoring systems have similar values in predicting mortality for acute mesenteric ischemia. Other considerations such as age, comorbid illness DM /HTN/ /CAD /CVA do influence the outcome.

• #8 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. […] 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. […] The final model showed increasing creatinine levels, decreasing pH as well as three radiological signs, namely atherosclerosis, vascular occlusion, and colonic ischemic involvement, as predictors for impaired survival. […] 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.

• #9

  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.

• #10

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

  Our report provides a comprehensive analysis of patients undergoing imaging for suspected AMI and outcomes of patients with confirmed IN undergoing surgery. 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. […] 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.

• #11 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) […] 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) […] In a review of 43 patients undergoing open mesenteric revascularization, the authors noted that 11 of the 23 patients undergoing a second-look operation required bowel resection.

• #12 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  Mesenteric ischemia is treatable and reversible when its caught early enough. […] Unfortunately, mesenteric ischemia in any form is a difficult condition to diagnose. Waiting for a diagnosis can delay treatment, and when treatment doesn’t happen quickly, acute mesenteric ischemia is often deadly. The death rate for the acute version of this condition is between 50% and 80%, especially when there are delays in treatment. When treatment happens in under 12 hours from when the blockage started, the death rate can be as low as 14%. Chronic mesenteric ischemia can also have long-term negative effects, either because of the risk of follow-up blood flow problems or nutrition difficulties. […] People with mesenteric ischemia also have a much higher risk of other ischemia-related conditions. These include heart attack, stroke, pulmonary embolism and more. Follow-up visits with your healthcare provider are very important to avoid long-term problems and reduce your risk for other life-threatening conditions.

• #13 Prognostic factors in patients with acute mesenteric ischemia

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

  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.

• #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

  The high risk of infection among patients with AMI outweighs the risks of acquired antibiotic resistance, and therefore broad-spectrum antibiotics should be administered early in the course of treatment. […] 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) […] 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. […] Endovascular revascularization procedures may have a role with partial arterial occlusion. (Recommendation 1C) […] The advent of endovascular approaches in parallel with modern imaging techniques may provide new options.

• #15 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). […] RI did not negatively influence patients short-term survival. However, the rate of secondary bowel resection was higher in patients with RI. This could be for two reasons. First, as discussed above, ischemia was more severe in patients with initial RI. Second, the clinical presentation (i.e., abdominal pain associated with increased CRP) may lead to more frequent surgical exploration and thus bowel resection. This shows the difficulty of managing RI, and the need to raise awareness about this event, which is underestimated and still poorly understood in clinical practice.

• #16

  https://link.springer.com/article/10.1007/s00423-022-02462-3

  The 3-year primary patency was 100% in the OT and 76.5% in the ET group with a statistical tendency for OT treatment. […] In our cohort, we see an increase of endovascular interventions during our study period with a trend to an improved technical success since 2011. […] Despite the increasing use of endovascular procedures with better perioperative outcomes, surgical therapy still plays an important role because of its higher technical success and presumably longer durability.

• #17

  https://link.springer.com/article/10.1007/s00423-022-02462-3

  Chronic mesenteric ischemia (CMI) is a rare but life-threatening disease. This study reviewed outcomes in patients treated surgically for CMI by open treatment (OT) and endovascular treatment (ET), analyzing risk factors for endovascular failure. The study’s primary endpoint was symptom-free survival. The secondary endpoint was the primary technical success for endovascular and open surgical treatments. Risk factors for endovascular failure were identified by using univariate analysis. […] Overall, in-hospital mortality was 2.8%, which was not statistically different between the groups. High-grade stenosis of the superior mesenteric artery tended to be associated with higher technical failure. […] ET showed a comparable perioperative outcome with higher technical failure. OT was distinguished by excellent early and late technical success.

• #18 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 associated mortality reported in the literature is more than 75% for mesenteric ischemia and depends on the mucosal ischemic damage stage of the colon (Faviers classification): Stage I is an ischemia limited to the mucosa (0% mortality), stage II is an ischemia extended to the muscularis mucosa with large ulcerations, and stage III is a transmural ischemia with necrosis of the muscularis and possible perforation (mortality 75%). […] The main issue for physicians about bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management and resulting in a poorer prognosis, especially after cardiac surgery.

• #19 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.

• #20 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. […] The BUN/albumin ratio was 1.04 in 90.9% of outpatients (p0.001). This ratio was 1.04 in 86.2% of patients in the ward follow-up (p0.001). On the other hand, the BUN/albumin ratio was 1.04 in 67.9% of ICU patients (p0.001).

• #21 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

  A biological scoring system based on PCT, ASAT, lactate, and myoglobin allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and to propose 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. […] 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.

• #22 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 poor prognosis of AMI was also related to the number of organ dysfunctions as illustrated by the results of the univariate and multivariate analysis. […] The prognostic value of arterial lactate concentration was also confirmed, and particularly the rise in arterial value within the first 24h following diagnosis. […] On the other hand, anticoagulation initiated following diagnosis was associated with a better outcome in arterial AMI. […] Derived from the multivariate analysis, we are proposing a predictive score of mortality that includes the maximal dose of vasopressors, the use of anticoagulation and the arterial delta lactate.

• #23 Prognostic Factors for Mortality in Acute Mesenteric Ischemia

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

  The aims of this paper are 1. to provide technical information about the optimal CTA (CT Angiography) protocol; 2. to explain the CTA arterial and venous supply to the gastrointestinal tract and the relevant ischemic pattern; and 3. to describe vascular, bowel, and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia. […] Surgery for acute mesenteric infarction (AMI) is associated with high mortality. This study aimed to generate a mortality prediction model to predict the 30-day mortality of surgery for AMI. […] Our prediction model, SAMIMS, allowed for the stratification of the patients’ 30-day-mortality risk of surgery for acute mesenteric infarction.

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