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Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases

Marc Leone| Carole Bechis| Karine Baumstarck| Alexandre Ouattara| Olivier Collange| Pascal Augustin| Djillali Annane| Charlotte Arbelot| Karim Asehnoune| Olivier Baldési| Simon Bourcier| Laurence Delapierre| Didier Demory| Baptiste Hengy| Carole Ichai| Eric Kipnis| Etienne Brasdefer| Sigismond Lasocki| Matthieu Legrand| Olivier Mimoz| Thomas Rimmelé| Jugurtha Aliane| Pierre-Marie Bertrand| Nicolas
Original
Volume 41, Issue 4 / April , 2015

Pages 667 - 676

Abstract

Background

In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.

Methods

A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.

Results

The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.

Conclusion

Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.

Keywords

References

  1. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia: a clinical review. Arch Intern Med 164:1054–1062
    • View reference on publisher's website
    • View reference on PubMed
  2. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC (2013) The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis. Acad Emerg Med 20:1087–1100
    • View reference on publisher's website
    • View reference on PubMed
  3. Gupta PK, Natarajan B, Gupta H, Fang X, Fitzgibbons RJ Jr (2011) Morbidity and mortality after bowel resection for acute mesenteric ischemia. Surgery 150:779–787
    • View reference on publisher's website
    • View reference on PubMed
  4. Vincent JL (2006) Organ dysfunction in patients with severe sepsis. Surg Infect (Larchmt) 7(Suppl 2):S69–S72
  5. Therneau TM, Atkinson EJ (2000) An introduction to recursive partitioning using the RPART routines. Technical report 61. Mayo Clinic, Rochester
  6. Roch A, Hraiech S, Masson E, Grisoli D, Forel JM, Boucekine M, Morera P, Guervilly C, Adda M, Dizier S, Toesca R, Collart F, Papazian L (2014) Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center. Intensiv Care Med 40:74–83
    • View reference on publisher's website
  7. Haga Y, Odo M, Homma M, Komiya K, Takeda K, Koike S, Takahashi T, Hiraka K, Yamashita H, Tanakaya K (2009) New prediction rule for mortality in acute mesenteric ischemia. Digestion 80:104–111
    • View reference on publisher's website
    • View reference on PubMed
  8. Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol O, Aldemir M (2013) Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg 98:76–81
    • View reference on publisher's website
    • View reference on PubMed
  9. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, Roque-Castellano C, Hernandez-Romero JM (2006) Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg 30:1579–1585
    • View reference on publisher's website
    • View reference on PubMed
  10. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800
    • View reference on publisher's website
    • View reference on PubMed
  11. Demir IE, Ceyhan GO, Friess H (2012) Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg 29:226–235
    • View reference on publisher's website
    • View reference on PubMed
  12. Reinhart K, Kuhn HJ, Hartog C, Bredle DL (2004) Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 30:1572–1578
  13. Casaer MP, Van den Berghe G (2014) Nutrition in the acute phase of critical illness. N Engl J Med 370:1227–1236
    • View reference on publisher's website
    • View reference on PubMed
  14. Berland T, Oldenburg WA (2008) Acute mesenteric ischemia. Curr Gastroenterol Rep 10:341–346
    • View reference on publisher's website
    • View reference on PubMed
  15. Lee SS, Park SH (2013) Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin N Am 51:29–43
    • View reference on publisher's website
    • View reference on PubMed
  16. Acosta S, Björck M (2014) Modern treatment of acute mesenteric ischaemia. Br J Surg 101:e100–e108
    • View reference on publisher's website
    • View reference on PubMed

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