Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

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ABSTRACT

Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.

1. Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;2:38. doi: 10.1186/s13017-017-0150-5.

2. Aouini F, Bouhaffa A, Baazaoui J, et al. Acute mesenteric ischemia: study of predictive factors of mortality. Tunis Med. 2012;90:533-536.

3. Yildirim D, Hut A, Tatar C, Dönmez T, Akıncı M, Toptaş M. Prognostic factors in patients with acute mesenteric ischemia. Turk J Surg. 2017;33:104-109. doi: 10.5152/UCD.2016.3534.

4. Mastoraki A, Mastoraki S, Tziava E, et al. Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol. 2016;7:125-130. doi: 10.4291/wjgp.v7.i1.125.

5. Acosta S. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion. World J Gatroenterol. 2014;20:9936-9941. doi: 10.3748/wjg.v20.i29.9936.

6. Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischemia. Eur J Trauma Emerg Surg. 2016;42:253-270. doi: 10.1007/s00068-016-0634-0.

7. Moschetta M, Telegrafo M, Rella L, et al. Multi-detector CT features of acute intestinal ischemia and their prognostic correlations. World J Radiol. 2014;6:130-138. doi: 10.4329/wjr.v6.i5.130.

8. Reginelli A, Iacobellis F, Berritto D, et al. Mesenteric ischemia: the importance of differential diagnosis for the surgeon. BMC Surg. 2013;13(Sl2):S51. doi: 10.1186/1471-2482-13-S2-S51.

9. Dhatt HS, Behr SC, Miracle A, Wang ZJ, Yeh BM. Radiological Evaluation of Bowel Ischemia. Radiol Clin North AM. 2015;53:1241-1254. doi: 10.1016/j.rcl.2015.06.009.

10. Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;256:93-101. doi:10.1148/radiol.10091938.

11. Aliosmanoglu I, Gul M, Kapan M, et al. Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg. 2013;98:76-81. doi: 10.9738/CC112.1.

12. Duran M, Pohl E, Grabitz K, Schelzig H, Sagban TA, Simon F. The importance of open emergency surgery in the treatment of acute mesenteric ischemia. World J Emerg Surg. 2015;10:45. doi: 10.1186/s13017-015-0041-6.

13. Klar E, Rahmanian PB, Bücker A, Hauenstein K, Jauch KW, Luther B. Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int. 2012;109:249-256. doi: 10.3238/arztebl.2012.0249.

14. Akyildiz HY, Sözüer E, Uzer H, Baykan M, Oz B. The length of necrosis and renal insufficiency predict the outcome of acute mesenteric ischemia. Asian J Surg. 2015;38:28-32. doi: 10.1016/j.asjsur.2014.06.001.

15. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia. Arch Intern Med. 2004;164:1054-1062. doi: 10.1001/archinte.164.10.1054.

16. Kougias P, Lau D, El Sayed HF, et al. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46:467-474. doi: 10.1016/j.jvs.2007.04.045.

17. Huang HH, Chang YC, Yen DH, et al. Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. J Chin Med Assoc. 2005;68:299-306. doi: 10.1016/S1726-4901(09)70165-0.

18. Rosero O, Harsányi L, Szíjártó A. Acute mesenteric ischemia: Do biomarkers contribute to diagnosis? Orv Hetil. 2014;155:1615-1623. doi: 10.1556/OH.2014.30013.

19. Simunic M, Fabijanic D, Perkovic N, et al. Acute mesenteric ischemia due to superior mesenteric artery embolism in a patient with permanent atrial fibrillation. Signa Vitae. 2010;5:40-43. doi: 10.22514/SV51.042010.6.

20. Wu MY, Lee LC, Chen YL, et al. Ischemic bowel disease due to superior mesenteric artery occlusion: A case report. Reports. 2018;1:10. doi:10.3390/reports1010010.

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