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Prognostic factors after acute mesenteric ischemia: which patients require specific management?

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Title: Prognostic factors after acute mesenteric ischemia: which patients require specific management?
Authors: De Pietro, Remi, Martin, Julie, Tradi, Farouk, Chopinet, Sophie, Barraud, Marine, Gaudry, Marine, Bourenne, Jeremy, Nafati, Cyril, Boussen, Salah, Guidon, Catherine, Bartoli, Michel, Mege, Diane
Source: International Journal of Colorectal Disease; 9/30/2023, Vol. 38 Issue 1, p1-11, 11p
Subject Terms: MESENTERIC ischemia, PROGNOSIS, OLDER patients, SURVIVAL rate, STROKE, DEATH rate, STRESS echocardiography
Abstract: Purpose: Diagnosis and treatment of AMI are a real issue for implicating physicians. In the literature, only one AMI stroke center has reported its results so far, with increasing survival rates. Our aim was to analyze acute mesenteric ischemia (AMI) related mortality and predictive factors, in a single academic center, before creating a dedicated intestinal stroke center. Methods: All the patients with an AMI, between January 2015 and December 2020, were retrospectively included. They were divided into 2 groups according to the early mortality: death during the first 30 days and alive. The 2 groups were compared. Results: 173 patients (57% of men), were included, with a mean age of 68 ± 16 years. Overall mortality rate was 61%. Mortality occurred within the first 30 days in 78% of dead cases. Dead patients were significantly older, more frequently admitted from intensive care, with more serious clinical, laboratory and radiological characteristics. We have identified 3 protective factors - history of abdominal surgery (Odd Ratio = 0.1; 95%CI = 0.01–0.8, p = 0.03), medical management with curative anticoagulation (OR = 0.09; 95%CI = 0.02–0.5, p = 0.004) and/or antiplatelets (OR = 0.04; 95%CI = 0.006–0.3, p = 0.001)-, and 2 predictive factors of mortality – age > 70 years (OR = 7; 95%CI = 1.4–37, p = 0.02) and previous history of coronaropathy (OR = 13; 95%CI = 1.7–93, p = 0.01). Conclusions: AMI is a severe disease with high morbidity and mortality rates. Even if its diagnosis is still difficult because of non-specific presentation, its therapeutic management needs to be changed in order to improve survival rates, particularly in patients older than 70 years with history of coronaropathy. Developing a dedicated organization would improve the diagnosis and the management of patients with AMI. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Colorectal Disease is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Prognostic factors after acute mesenteric ischemia: which patients require specific management?
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  Data: International Journal of Colorectal Disease; 9/30/2023, Vol. 38 Issue 1, p1-11, 11p
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  Data: <searchLink fieldCode="DE" term="%22MESENTERIC+ischemia%22">MESENTERIC ischemia</searchLink><br /><searchLink fieldCode="DE" term="%22PROGNOSIS%22">PROGNOSIS</searchLink><br /><searchLink fieldCode="DE" term="%22OLDER+patients%22">OLDER patients</searchLink><br /><searchLink fieldCode="DE" term="%22SURVIVAL+rate%22">SURVIVAL rate</searchLink><br /><searchLink fieldCode="DE" term="%22STROKE%22">STROKE</searchLink><br /><searchLink fieldCode="DE" term="%22DEATH+rate%22">DEATH rate</searchLink><br /><searchLink fieldCode="DE" term="%22STRESS+echocardiography%22">STRESS echocardiography</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: Diagnosis and treatment of AMI are a real issue for implicating physicians. In the literature, only one AMI stroke center has reported its results so far, with increasing survival rates. Our aim was to analyze acute mesenteric ischemia (AMI) related mortality and predictive factors, in a single academic center, before creating a dedicated intestinal stroke center. Methods: All the patients with an AMI, between January 2015 and December 2020, were retrospectively included. They were divided into 2 groups according to the early mortality: death during the first 30 days and alive. The 2 groups were compared. Results: 173 patients (57% of men), were included, with a mean age of 68 ± 16 years. Overall mortality rate was 61%. Mortality occurred within the first 30 days in 78% of dead cases. Dead patients were significantly older, more frequently admitted from intensive care, with more serious clinical, laboratory and radiological characteristics. We have identified 3 protective factors - history of abdominal surgery (Odd Ratio = 0.1; 95%CI = 0.01–0.8, p = 0.03), medical management with curative anticoagulation (OR = 0.09; 95%CI = 0.02–0.5, p = 0.004) and/or antiplatelets (OR = 0.04; 95%CI = 0.006–0.3, p = 0.001)-, and 2 predictive factors of mortality – age > 70 years (OR = 7; 95%CI = 1.4–37, p = 0.02) and previous history of coronaropathy (OR = 13; 95%CI = 1.7–93, p = 0.01). Conclusions: AMI is a severe disease with high morbidity and mortality rates. Even if its diagnosis is still difficult because of non-specific presentation, its therapeutic management needs to be changed in order to improve survival rates, particularly in patients older than 70 years with history of coronaropathy. Developing a dedicated organization would improve the diagnosis and the management of patients with AMI. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: <i>Copyright of International Journal of Colorectal Disease is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s00384-023-04540-4
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        Text: English
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      – SubjectFull: MESENTERIC ischemia
        Type: general
      – SubjectFull: PROGNOSIS
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      – SubjectFull: STROKE
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      – SubjectFull: STRESS echocardiography
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              Text: 9/30/2023
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