Mortality in Acute Arterial Mesenteric Ischemia: A Single-Center Experience

Year 2021, Volume: 11 Issue: 3, 601 - 607, 22.09.2021

Guner Cakmak Kayhan Özdemir , Barış Mantoğlu , Merve Yiğit , Uğur Can Dülger

https://doi.org/10.31832/smj.947804

Cited By: 1

Abstract

Abstract

Background : Acute mesenteric ischemia (AMI) is a life-threatening pathology that often requires urgent surgical intervention. It is frequently faced in elderly patients. Despite advances in the diagnosis of AMI morbidity, and mortality rates are still high. The presence of comorbidities delayed surgical intervention due to diagnostic difficulties, and in most cases, older patients with heart problems may be remarkable factors for higher mortality rates. Diagnostic challenges are tried to be overcome with both imaging methods and laboratory findings. Unfortunately, to date, no clear laboratory parameters have been described in diagnosing or predicting mortality of mesenteric ischemia.

Materials and Methods : The patients diagnosed with acute arterial mesenteric ischemia between the dates 2010-2019 were enrolled in the study. Demographic characteristics, diagnostic biochemical parameters (lymphocyte, neutrophil, albumin, C-reactive protein, lactate, lactate dehydrogenase, Di-Dimer, troponin, white blood count, platelet, fibrinogen, creatine kinase-MB) levels, as well as comorbidities of the patients, were evaluated.

Results : A total of 149 patients was enrolled in the study, with a mean age of 66.11 . In the non-survivor group, neutrophil, RDW, lactate, DDM, Fibrinogen, and CK-MB levels, furthermore albumin levels were defined as significantly elevated in the survivor group (p0.05). Hypertension was the major comorbidity by far in both groups.

Conclusion : High levels of fibrinogen, lactate, DDM, CK-MB levels and low levels of albumin levels may be predictors of mortality in mesenteric ischemia.

Keywords

Mesenteric ischemia, Mortality, Predictive factors

Akut Arteryel Mezenterik İskemide Mortalite: Tek Merkez Deneyimi

Abstract

Özet

Amaç : Akut mezenterik iskemi (AMI), sıklıkla acil cerrahi müdahale gerektiren hayatı tehdit eden bir patolojidir. Yaşlı hastalarda sıklıkla karşılaşılmaktadır. AMI tanısındaki gelişmelere rağmen morbidite ve mortalite oranları hala yüksektir. Komorbiditelerin varlığı, tanısal zorluklar nedeniyle cerrahi müdahaleyi geciktirir ve genellikle kardiyak problemleri olan yaşlı hastalar, daha mortal seyredebilirler. Gerek görüntüleme yöntemleri gerekse laboratuvar bulguları ile tanısal zorluklar aşılmaya çalışılmaktadır. Günümüzde halen mezenterik iskeminin mortalitesini teşhis etmek veya tahmin etmek için net bir laboratuvar parametresi tanımlanmamıştır.

Gereç-Yöntemler : 2010-2019 tarihleri arasında akut arteriyel mezenterik iskemi tanısı alan hastalar çalışmaya dahil edildi. Demografik özellikler, tanısal biyokimyasal parametreler (lenfosit, nötrofil, albümin, C-reaktif protein, laktat, laktat dehidrojenaz, D-Dimer, troponin, beyaz kan sayımı, trombosit, fibrinojen, kreatin kinaz-MB) seviyeleri ve ayrıca komorbiditeler değerlendirildi.

Bulgular : Çalışmaya yaş ortalaması 66.11 olan toplam 149 hasta alındı. Mortal seyirli grupta nötrofil, RDW, laktat, DDM, Fibrinojen ve CK-MB seviyeleri, ayrıca albümin seviyeleri hayatta kalan grupta anlamlı olarak yüksek olarak tanımlandı (p < 0.05). Her iki grupta da açık ara en önemli komorbidite hipertansiyondu.

Sonuç : Yüksek fibrinojen, laktat, DDM, CK-MB seviyeleri ve düşük albümin seviyeleri mezenterik iskemide mortaliteyi saptamada prediktif faktörler olabilirler.

Keywords

Mezenterik iskemi, Mortalite, Prediktif faktörler

References

• 1. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, Di Saverio S, Fraga GP CF. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12(38).
• 2. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW HB. The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Acad Emerg Med. 2013;20(11):1087-1100.
• 3. Memet O, Zhang L SJ. Serological biomarkers for acute mesenteric ischemia. Ann Transl Med. 2019;7(16):394.
• 4. Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT LP. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46(3):467-474.
• 5. Stamatakos M, Stefanaki C, Mastrokalos D, Arampatzi H, Safioleas P, Chatziconstantinou C, Xiromeritis C SM. Mesenteric ischemia: still a deadly puzzle for the medical community. Tohoku J Exp Med. 2008;216(3):197204.
• 6. Kaleya RN BS. Acute mesenteric ischemia. Crit Care Clin. 1995;11(2):479-512.
• 7. Brandt LJ BS. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology. 2000;118(5):954-968.
• 8. Kirkpatrick ID, Kroeker MA GH. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229(1):91-98.
• 9. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ BC. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164(10):1054-1062.
• 10. Luther B, Mamopoulos A, Lehmann C KE. The Ongoing Challenge of Acute Mesenteric Ischemia. Visc Med. 2018;34(3):217-213.
• 11. Boley SJ, Brandt LJ SR. History of mesenteric ischemia. The evolution of a diagnosis and management. Surg Clin North Am. 1997;77(2):275-288.
• 12. Schwartz LB GB. Mesenteric ischemia. Surg Clin North Am. 1997;77:275-5002.
• 13. Mamode N, Pickford I LP. Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg. 1999;165(3):203-208.
• 14. AJ, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K YH. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016;42(2):253-270.
• 15. Clair DG BJ. Mesenteric Ischemia. N Engl J Med. 2016;374(10):959-968.
• 16. S A. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010;23(1):4-8.
• 17. Treskes N, Persoon AM van ZA. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Intern Emerg Med. 2017;12(6):821-836.
• 18. Huang HH, Chang YC, Yen DH, Kao WF, Chen JD, Wang LM, Huang CI LC. Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. J Chin Med Assoc. 2005;68(7):299-306.
• 19. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, Roque-Castellano C H-RJ. Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg. 2006;30(8):1579-1585.
• 20. Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol O AM. Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg. 2013;98(1):76-81.
• 21. Mamode N, Pickford I LP. Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg. 1999;165(3):203-208.
• 22. Derikx JP, Schellekens DH AS. Serological markers for human intestinal ischemia: A systematic review. Best Pr Res Clin Gastroenterol. 2017;31(1):69-74.