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Murata T, Yamaguchi N, Shimomoto Y, Mikajiri Y, Sasaki Y, Konagaya K, Igarashi Y, Sawamura N, Yamamoto K, Kume N, Suno Y, Kurata S, Kasetani T, Kato I, Nishida T, Hirata H, Miyake K, Oonishi T, Isogai N, Fukai R, Kanomata H, Shimoyama R, Kashiwagi H, Takenoue T, Terashima T, Murayama H, Kohriki S, Morita T, Takaki M, Ogino H, Kanemaru T, Sano K, Kurogi N, Watanabe K, Hirata M, Kawachi J. Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study. Int J Surg 2023; 109:4119-4125. [PMID: 37720948 PMCID: PMC10720829 DOI: 10.1097/js9.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis. MATERIALS AND METHODS In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors. RESULTS Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10. CONCLUSION This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.
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Affiliation(s)
| | | | - Yutaro Shimomoto
- Department of General Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
| | - Yumi Mikajiri
- Department of General Surgery, Shonan Atsugi Hospital
| | - Yuki Sasaki
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Kensuke Konagaya
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Naoki Sawamura
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Kota Yamamoto
- Department of General Surgery, Shonan Atsugi Hospital
| | - Nao Kume
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Shuji Kurata
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Tetsuya Kasetani
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | - Ichiro Kato
- Department of General Surgery, Sendai Tokushukai Hospital, Miyagi
| | | | - Hirohisa Hirata
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | | | - Takahisa Oonishi
- Department of General Surgery, Yamato Tokushukai Hospital, Kanagawa
| | | | | | | | | | | | | | | | - Hiroyuki Murayama
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | - Shunsaku Kohriki
- Department of General Surgery, Shonan Fujisawa Tokushukai Hospital
| | - Takeshi Morita
- Department of General Surgery, Matsubara Tokushukai Hospital, Osaka
| | - Mutsuo Takaki
- Department of General Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
| | - Hidemitsu Ogino
- Department of General Surgery, Narita Tomisato Tokushukai Hospital, Chiba
| | | | - Ken Sano
- Department of General Surgery, Sendai Tokushukai Hospital, Miyagi
| | | | - Kazunao Watanabe
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital
| | - Masahiro Hirata
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital
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Yu B, Ko RE, Yoo K, Gil E, Choi KJ, Park CM. Non-occlusive mesenteric ischemia in critically ill patients. PLoS One 2022; 17:e0279196. [PMID: 36534676 PMCID: PMC9762570 DOI: 10.1371/journal.pone.0279196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is a life-threatening acute condition that has an overall in-hospital mortality rate of up to 75%. Critically ill patients are often admitted to intensive care units (ICUs) due to shock, and these patients are frequently at risk of developing NOMI. The objective of this study was to determine the clinical features of critically ill patients with NOMI and evaluate the risk factors for in-hospital mortality among these patients. METHODS We reviewed the electronic medical records of 7,346 patients who underwent abdominal contrast-enhanced computed tomography during their ICU stay at Samsung Medical Center (Seoul, Korea) between January 1, 2010 and December 31, 2019. After reviewing each patient's computed tomography (CT) scans, 60 patients were diagnosed with NOMI and included in this analysis. The patients were divided into survivor (n = 23) and non-survivor (n = 37) groups according to the in-hospital mortality. RESULTS The overall sequential organ failure assessment (SOFA) score for the included patients upon admission to the ICU was 8.6 ± 3.1, and medical ICU admissions were most common (66.7%) among the patients. The SOFA score upon admission to the ICU was higher for the non-survivors than for the survivors (9.4 vs. 7.4; p = 0.017). Non-survivors were more often observed in the medical ICU admissions (39.1% vs. 83.8%) than in the surgical ICU admissions (47.8% vs. 10.8%) or the cardiac ICU admissions (13.0% vs. 5.4%). Laboratory test results, abdominal CT findings, and the use of vasopressors and inotropes did not differ between the two groups. In a multivariable analysis, SOFA scores >8 upon admission to the ICU (odds ratio [OR] 4.51; 95% 1.12-18.13; p = 0.034), patients admitted to the ICU with medical problems (OR 7.99; 95% 1.73-36.94; p = 0.008), and abdominal pain (OR 4.26; 95% 1.05-17.35; p = 0.043) were significant prognostic predictors for in-hospital mortality. CONCLUSIONS The SOFA score >8 upon admission to the ICU, admission to the ICU for medical problems, and abdominal pain at diagnosis are associated with increased mortality among patients with NOMI.
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Affiliation(s)
- Byunghyuk Yu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Intensive Care Unit, Kyungpook National University Chilgok Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keesang Yoo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eunmi Gil
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Jin Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (KJC); (CMP)
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (KJC); (CMP)
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Wu W, He J, Zhang S, Zeng C, Wang Q. Basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia: a systematic review and proportional meta-analysis. Scand J Gastroenterol 2022; 58:605-618. [PMID: 36458699 DOI: 10.1080/00365521.2022.2152289] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE The aim of this systematic review and meta-analysis was to examine and assess the basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia (AMI) and its various subtypes. PATIENTS AND METHODS A literature search was conducted by using the databases PubMed, EMBASE, and Google Scholar (to June 1, 2022). Random-effects or fixed-effects models were selected to pool means and proportions and their corresponding 95% confidence intervals (CI), based on heterogeneity between studies. The results of meta-analyses for basic demographic characteristics and prevalence (proportions) of each specific comorbidities of acute mesenteric ischemia (AMI) and its various subtypes were described. RESULTS Ninety-nine studies were included in the meta-analysis, including 17,103 patients with AMI. Furthermore, 7941 patients with subclass diagnoses of AMI were identified, including 3,239 patients with arterial occlusive mesenteric ischemia (AOMI), 2,977 patients with nonocclusive mesenteric ischemia (NOMI), and 1,725 patients with mesenteric venous thrombosis (MVT). As a surgical emergency, AMI is associated with older patients and a high likelihood of multisystem comorbidities. Comorbidities of AMI involved multiple systemic diseases, including cardiovascular disease, endocrine and metabolic diseases, kidney diseases, digestive diseases, respiratory diseases, cerebrovascular diseases, vascular diseases, and cancer. CONCLUSION The basic demographic characteristics and the prevalence of comorbidities of different subtypes of AMI are different. The management of comorbidities should be an essential part of improving the prognosis of AMI patients and may contribute to precise prevention of AMI.
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Affiliation(s)
- Wenhan Wu
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jia He
- Faculty Affairs and Human Resources Management Department, Southwest Medical University, Luzhou, China
| | - Shijian Zhang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Changtong Zeng
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Qifa Wang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
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