New prediction rule for mortality in acute mesenteric ischemia

Acute mesenteric ischemia is potentially fatal, but prognostic factors have not yet been established. This study was undertaken to elucidate them.

This is a retrospective cohort study, consisting of 110 patients who had been treated in the past 5 years, from 26 national hospitals in Japan.

The overall in-hospital mortality rate was 51%. Logistic regression analysis demonstrated two independent prognostic factors, electrocardiogram scale with an odds ratio of 1.7 (95% CI 1.2-2.4) and shock index of 11 (95% CI 1.5-80). A stepwise analysis gave a prediction equation for in-hospital mortality (R) using these variables and age score. We further modified this equation to a simpler scoring system (S) using the same variables. Both R and S showed a good discriminatory ability as determined by areas under the receiver-operating characteristic curve (0.83, 95% CI: 0.74-0.91 for R; 0.82, 95% CI 0.74-0.91 for S). The observed mortality rates increased as the R or S increased (19% at R <0.25, 41% at 0.25 < or = R <0.6, 85% at R > or =0.6; 19% at S < or =2, 37% at S of 3 or 4, 91% at S > or =5).

The new prediction rules can be used at any hospital and may be promising tools for medical decision-making, informed consent and reviewing quality of care.