Journal Article

Prognostic factors of acute mesenteric ischemia in ICU patients

Castanares-Zapatero, Diego, Laterre, Pierre-François, Hantson, Philippe, Caluwaerts, Martin

2019

Overview

Background The primary endpoint was to investigate the prognostic factors of acute mesenteric ischemia (AMI) in ICU patients. Methods Retrospective observational, non-interventional, monocentric study of a cohort of 214 ICU patients with a confirmed diagnosis of arterial AMI. Results We collected demographics, mortality, hospital stay, prior medical history, comorbidities, reasons for ICU admission, laboratory investigations, diagnostic procedures, therapy, severity scores. The 30-day mortality rate was 71% for the 214 patients with arterial AMI. The incidence of nonocclusive mesenteric ischemia was particularly high. AMI was a secondary diagnosis in 58% of patients. Half of the population was represented by surgical patients who mostly required an urgent procedure. The mortality rate was not different in the subgroup with aortic surgery. Three factors were associated with an increase or decrease in mortality: the maximal dose of vasopressors (VP) administered to the patient (OR = 1.20; 95%CI = 1.08–1.33; p  <  0.001), arterial change in lactate values within the first 24 h of admission (OR = 1.24; 95%CI = 1.05–1.48; p  = 0.012) and anticoagulation (OR = 0.19; 95%CI = 0.043–0.84; p  = 0.029). Conclusions Fatalities after AMI were related to a high incidence of multi-organ failure. The monitoring of arterial lactate appeared helpful to identify the patients with a poor prognosis.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Acute Disease / Aged / Aged, 80 and over / Anticoagulants / Anticoagulants - therapeutic use / Aorta / Arterial acute mesenteric ischemia / Clinical medicine / Comorbidity / Data collection / Demography / Diagnosis / Family medical history / Female / Gastroenterology / Health aspects / Hepatology / Hospital Mortality / Hospital patients / Hospitals / Humans / ICU patients / Incidence / Intensive care / Intensive Care Units / Internal Medicine / Intestinal disorders / Ischemia / Kidney diseases / Lactates / Lactic acid / Lactic Acid - blood / Length of Stay / Male / Medical imaging / Medicine / Medicine & Public Health / Mesenteric Ischemia - epidemiology / Mesenteric Ischemia - mortality / Mesenteric Ischemia - surgery / Middle Aged / Mortality / Multiple Organ Failure - epidemiology / Non-pharmacological intervention / Patient outcomes / Patients / Peritoneal diseases / Prognosis / Prognostic factors / Research Article / Retrospective Studies / Sepsis / Sepsis - epidemiology / Software / Statistics / Studies / Surgery / Systematic review / Tomography / Urine / Vasoconstrictor Agents - administration & dosage / Vice presidents (Organizations)