Predictive factors of mortality in patients with acute mesenteric ischemia. A retrospective study.

Abstract

AIM: The aim of this retrospective study was to evaluate the impact of some risk factors on mortality in patients with Acute mesenteric ischemia (AMI).

MATERIALS AND METHODS: From September 2003 to August 2011, 200 patients were operated on for bowel infarction at our unit: 149 were included in the study. For each patient, socio-demographic (gender and age) and clinical data (extent of necrosis, predisposing factors, WBC, LDH, comorbidities) were collected from patients’ clinical records.

RESULTS: Of the 149 patients who underwent surgery, 57 (38.3%) died. A significantly higher mortality was associated with older age (79.9 versus 74.2 years, p < 0.01), higher LDH serum levels (695 versus 636 UI/L, p < 0.01), higher WBC (25.1 versus 22.5 X 103/mm3; p < 0.01), and extent of necrosis (p< 0.01). Otherwise, there was no correlation between comorbidities and mortality. Finally, multivariate analysis confirmed the significantly higher risk of death in patients with right colon and massive small bowel infarction (adjOR= 3.58; 95% CI=1.36-9.42) and intestinal perforation (adjOR=31.1; 95% CI=2.45-395.7).

DISCUSSION: The results of our study suggest that the contribution of laboratory tests is limited, even if increased indexes of necrosis (such as LDH) associated with neutrophilic leukocytosis and metabolic acidosis, may help in defining diagnosis/prognosis, though with low accuracy.

CONCLUSIONS: The extent of necrosis and diagnostic delay seem to be the most important prognostic factors even after adjusting for confounding due to age, presence of comorbidities, and laboratory tests (LDH and WBC).