Prognostic Factors for Mortality in Acute Mesenteric Ischemia

Area of Science:

• Vascular Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Postoperative mortality in patients with acute mesenteric ischemia (AMI) remains a significant clinical challenge.
• Identifying predictors of mortality is crucial for improving patient outcomes in AMI management.

Purpose of the Study:

• To investigate clinical predictors of postoperative mortality in a large European cohort of patients treated for AMI.
• To identify key factors influencing outcomes in patients undergoing surgical and/or interventional treatment for AMI.

Main Methods:

• Retrospective analysis of 179 patients treated for AMI between 2009 and 2021.
• Univariate and multivariable binary logistic regression analysis to assess associations between clinical variables and postoperative mortality.
• Subanalysis excluding patients with a fatal prognosis at initial surgical exploration.

Main Results:

• Overall in-hospital mortality was 55.9%.
• Independent predictors of mortality included leukocytes, lactate, bilirubin, creatinine, etiology (arterial, venous, or non-occlusive mesenteric ischemia), and portomesenteric vein gas (PMVG).
• In a subanalysis, leukocytes, lactate, etiology, PMVG, and intraoperative fresh frozen plasma (FFP) transfusion predicted mortality; higher preoperative lactate values significantly increased fatal outcome risk.

Conclusions:

• Clinical and radiological characteristics, both pre- and intraoperative, determine the outcome of AMI patients.
• Serum lactate is a critical predictor, with risk disproportionately increasing with higher values.
• Leukocytes, lactate, etiology, and PMVG are significant independent predictors of postoperative mortality in AMI.