Abstract
Objective: Acute mesenteric ischemia is potentially fatal, but prognostic factors have not yet been established. This study was undertaken to elucidate them. Methods: This is a retrospective cohort study, consisting of 110 patients who had been treated in the past 5 years, from 26 national hospitals in Japan. Results: The overall in-hospital mortality rate was 51%. Logistic regression analysis demonstrated two independent prognostic factors, electrocardiogram scale with an odds ratio of 1.7 (95% CI 1.2–2.4) and shock index of 11 (95% CI 1.5–80). A stepwise analysis gave a prediction equation for in-hospital mortality (R) using these variables and age score. We further modified this equation to a simpler scoring system (S) using the same variables. Both R and S showed a good discriminatory ability as determined by areas under the receiver-operating characteristic curve (0.83, 95% CI: 0.74–0.91 for R; 0.82, 95% CI 0.74–0.91 for S). The observed mortality rates increased as the R or S increased (19% at R <0.25, 41% at 0.25 ≤ R <0.6, 85% at R ≥0.6; 19% at S ≤2, 37% at S of 3 or 4, 91% at S ≥5). Conclusion: The new prediction rules can be used at any hospital and may be promising tools for medical decision-making, informed consent and reviewing quality of care.
Journal Section:
Original Paper
References
1.
Brandt LJ, Boley SJ: Intestinal ischaemia; in Feldman M, Friedman LS, Sleisenger MH (eds): Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Philadelphia, Saunders, 2002, pp 2321–2340.
2.
Kozuch PL, Brandt LJ: Diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 2005;21:201–215.
[PubMed]
3.
Greenwald DA, Brandt LJ, Reinus JF: Ischemic bowel disease in the elderly. Gastroenterol Clin North Am 2001;30:445–473.
[PubMed]
4.
American Gastroenterological Association Clinical Practice and Practice Economics Committee: AGA Technical Review on Intestinal Ischemia. Gastroenterology 2000;118:954–968.
[PubMed]
5.
Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM: Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 2004;91:17–27.
[PubMed]
6.
The American Gastroenterological Association Clinical Practice and Practice Economics Committee: American Gastroenterological Association Medical Position Statement: Guidelines on Intestinal Ischemia. Gastroenterology 2000;118:951–953.
[PubMed]
7.
Wain RA, Hines G: Surgical management of mesenteric occlusive disease: a contemporary review of invasive and minimally invasive techniques. Cardiol Rev 2008;16:69–75.
[PubMed]
8.
Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD: Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004;164:1054–1062.
[PubMed]
9.
Lyon C, Clark DC: Diagnosis of acute abdominal pain in older patients. Am Fam Physician 2006;74:1537–1544.
[PubMed]
10.
Herbert GS, Steele SR: Acute and chronic mesenteric ischemia. Surg Clin North Am 2007;87:1115–1134.
[PubMed]
11.
Burns BJ, Brandt LJ: Intestinal ischemia. Gastroenterol Clin N Am 2003;32:1127–1143.
[PubMed]
12.
Yosuhara H: Acute mesenteric ischemia: the challenge of gastroenterology. Surg Today 2005;35:185–195.
[PubMed]
13.
Kougias P, Lau D, El Sayed HF: Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg 2007;46:467–474.
[PubMed]
14.
Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, et al: Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg 2006;30:1579–1585.
[PubMed]
15.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–1379.
[PubMed]
16.
Siegelman SS, Sprayregen S, Boley SJ: Angiographic diagnosis of mesenteric arterial vasoconstriction. Radiology 1974;112:533–542.
[PubMed]
17.
Copeland GP, Jones D, Walters M: POSSUM: a scoring system for surgical audit. Br J Surg 1991;78:356–360.
18.
Doglietto GB, Gallitelli L, Pacelli F, Bellantone R, Malerba M, Sgadari A, Crucitti F: Protein-sparing therapy after major abdominal surgery: lack of clinical effects. Ann Surg 1996;223:357–362.
[PubMed]
19.
Rady MY, Nightingale P, Little RA, Edwards JD: Shock index: a re-evaluation in acute circulatory failure. Resuscitation 1992;23:227–234.
[PubMed]
20.
Hosmer DW, Lemeshow S: Applied Logistic Regression. New York, Wiley, 1989.
21.
Akobeng AK: Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Pædiatrica 2007;96:644–647.
22.
Charles A, Shaikh AA, Walters M, Huehl S, Pomerantz R: Blood transfusion is an independent predictor of mortality after blunt trauma. Am Surgeon 2007;73:1–5.
[PubMed]
23.
Toosi MS, Merlino JD, Leeper KV: Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism. Am J Cardiol 2008;101:700–705.
[PubMed]
24.
Ledoux D, Canivet JL, Preiser JC, Lefrancq J, Damas P: SAPS 3 admission score: an external validation in a general intensive care population. Intensive Care Med 2008;34:1873–1877.
[PubMed]
25.
Haga Y, Wada Y, Takeuchi H, Kimura O, Furuya T, Sameshima H, Ishikawa M: ‘Estimation of Physiological Ability and Surgical Stress’ (E-PASS) for a surgical audit in elective digestive surgery. Surgery 2004;135:586–594.
[PubMed]
26.
Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV: Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 2006;244:371–380.
[PubMed]
© 2009 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2009
You do not currently have access to this content.
