Predictors of Mortality in Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis

To highlight predictors of mortality in acute mesenteric ischemia (AMI) by conducting a meta-analysis of all relevant published studies.

PubMed, Cochrane, and Google Scholar were searched from their inception till October 31, 2021. Studies evaluating predictors of mortality were selected. Only those factors were selected for meta-analysis that was reported by at least four studies. Meta-analysis was performed on selected factors using the random-effects model by using Revman 5.3 software.

Fifty-one studies were included evaluating 10,425 patients of AMI. Studies selected had a low risk of bias (Median = 7). Thirty-three factors were evaluated in our review. Age (OR 1.17, 95% CI 1.08-1.27), chronic renal disease (OR 2.47, 95% CI 1.37-4.45), patient dependency (OR 3.01, 95% CI 1.95-4.65), arrhythmias (OR 1.93, 95% CI 1.38-2.69), cardiac failure (OR 2.28, 95% CI 1.57-3.31), hypotension (OR 3.44, 95% CI 1.81-6.54), large bowel involvement (OR 2.98, 95% CI 1.44-6.17), small and large bowel involvement (OR 1.86, 95% CI 1.23-2.81), creatinine (OR 1.67, 95% CI 1.27-2.20), lactate (OR 1.43, 95% CI 1.26-1.62), delay to surgery (OR 2.51, 95% CI 1.58-3.99) and inotropes (OR 3.79, 95% CI 1.47-9.77) were significantly associated with mortality. On the contrary bowel wall thickening (OR 0.53, 95% CI 0.38-0.88), anticoagulation (OR 0.27, 95% CI 0.10-0.74), and revascularization (OR 0.30, 95% CI 0.13-0.69) were significantly associated with survival.

In conclusion, Age, chronic renal disease, diabetes, patient dependency, arrhythmias, cardiac failure, hypotension, large bowel involvement, small & large bowel involvement, creatinine, lactate, delay to surgery, and inotropes were significantly associated with mortality while anticoagulants, revascularization and bowel thickening on CT was associated with decreased mortality.