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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Association of COVID-19 Infection and Acute Mesenteric Ischemia
Ognen Kostovski1, Irena Lazarova1, Bojan Popchanovski1
1University Clinic for Digestive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia.
Abstract:
COVID-19 is an infectious disease that is considered to be a thromboinflammatory disorder. The study was aimed to determine the prevalence of COVID-19 in patients with acute mesenteric ischemia (AMI) and the outcomes of surgical treatment in relation to COVID-19. A total of 140 patients were included in this multicentric study divided into two groups: the test group (n=65) consisted of cases of AMI detected during the COVID-19 pandemic and the control group (n=65) consisted of cases of AMI detected before the pandemic. Test group patients were classified as COVID-positive (COVID+), or COVID-negative (COVID-) if they tested positive, respectively negative test for COVID-19 on admission. Primary outcomes were: prevalence of COVID-19 infection among test group patients, association between COVID-19 infection and inoperability, and between COVID-19 and treatment outcome. Secondary outcomes were association between each blood parameter and inoperability and treatment outcome. There were no statistically significant differences between inoperability and COVID-19 positivity on admission, overall mortality between the control group and the test group and overall mortality between COVID+ and COVID- patients, as well as among those patients that have been surgically treated (p>0.05). There were statistically significant differences between serum amylase levels (p=0.034), and serum LDH levels (p=0.0382) and inoperability, between serum LDH levels and postoperative mortality (p=0.0151), and overall mortality (p=0.00163). High level of LDH and serum pancreatic amylase are associated with a higher rate of inoperability and a higher postoperative and overall mortality rate. COVID-19 does not seem to independently influence the treatment outcome of AMI.
Insights
COVID-19 did not independently impact surgical outcomes for acute mesenteric ischemia (AMI). However, elevated lactate dehydrogenase (LDH) and serum pancreatic amylase levels correlated with higher inoperability and mortality rates in AMI patients.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Gastroenterology
Background:
- COVID-19 is a thromboinflammatory disease.
- Acute mesenteric ischemia (AMI) is a surgical emergency.
- The impact of COVID-19 on AMI outcomes requires investigation.
Purpose of the Study:
- To determine COVID-19 prevalence in AMI patients.
- To assess the association between COVID-19 infection and surgical treatment outcomes for AMI.
- To identify predictors of inoperability and mortality in AMI.
Main Methods:
- Multicentric study comparing 140 AMI patients (65 during COVID-19 pandemic, 65 prior).
- Patients during the pandemic were classified as COVID-positive or COVID-negative.
- Outcomes analyzed included prevalence, inoperability, and mortality.
Main Results:
- No significant difference in inoperability or mortality between COVID-19 positive and negative AMI patients.
- No significant difference in overall mortality between pandemic and pre-pandemic AMI cohorts.
- Elevated serum LDH and pancreatic amylase levels were significantly associated with increased inoperability and mortality.
Conclusions:
- COVID-19 infection does not appear to independently affect surgical treatment outcomes in acute mesenteric ischemia.
- Serum LDH and pancreatic amylase levels are significant predictors of poor outcomes in AMI patients.
- Further research into thromboinflammatory markers in AMI is warranted.
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