Decision Tool for Predicting Outcomes in Geriatric Acute Mesenteric Ischemia

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Medical Informatics

Background:

• Acute mesenteric ischemia (AMI) is a severe condition predominantly affecting elderly patients with comorbidities.
• Early intervention in AMI is crucial but can lead to costly and potentially futile treatments.
• Predicting mortality risk is essential for guiding patient care and family discussions.

Purpose of the Study:

• To develop a prognostic tool for practitioners to assess the risk of mortality in patients with AMI.
• To identify key clinical variables that predict adverse outcomes in this patient population.

Main Methods:

• Retrospective chart review of patients diagnosed with AMI over a decade, excluding those under 65.
• Univariate analysis to identify significant risk factors for mortality.
• Decision tree analysis to construct a predictive model for death risk.

Main Results:

• Lactate levels on the day of surgery (DOS) and pressor requirements were significant predictors of death (P ≤ 0.001).
• A decision tree model identified distinct risk strata: 79% mortality with DOS lactate ≥5.4; 70% mortality with DOS lactate <5.4, pressors, and creatinine >1.18; and 6.1% mortality with DOS lactate <5.4, creatinine <1.54, and no pressors.
• The developed tool demonstrated an 82% predictive accuracy for outcomes in the study population.

Conclusions:

• A prognostic tool incorporating day of surgery lactate, creatinine, and pressor requirements can effectively predict mortality in elderly patients with AMI.
• This tool can aid clinicians in setting realistic expectations for patients and families and in guiding critical treatment decisions.
• Further validation of this tool in diverse clinical settings is warranted.