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Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis
Yu Xu1, Shang-Tai Dai2, Hong-Qiao Lu2
1Panzhihua Central Hospital, 34 Yikang St, 617000, Panzhihua, Sichuan Province, China.
Objective:
Acute mesenteric vein thrombosis (AMVT) is an acute abdominal disease with onset, rapid progression, and extensive intestinal necrosis that requires immediate surgical resection. The purpose of this study was to determine the risk factors for nosocomial intestinal resection in patients with AMVT.
Methods:
We retrospectively analysed 64 patients with AMVT diagnosed by CTA at the Affiliated Hospital of Kunming University of Science and Technology from January 2013 to December 2021. We compared patients who underwent intestinal resection (42 patients) with those who did not undergo intestinal resection (22 patients). The area under the ROC curve was evaluated, and a forest map was drawn.
Results:
Among the 64 patients, 6 (9.38%) had a fever, 60 (93.75%) had abdominal pain, 9 (14.06%) had a history of diabetes, 8 (12.5%) had a history of deep vein thrombosis (DVT), and 25 (39.06%) had ascites suggested by B ultrasound or CT after admission. The mean age of all patients was 49.86 ± 16.25 years. The mean age of the patients in the enterectomy group was 47.71 ± 16.20 years. The mean age of the patients in the conservative treatment group (without enterectomy) was 53.95 ± 15.90 years. In the univariate analysis, there were statistically significant differences in leukocyte count (P = 0.003), neutrophil count (P = 0.001), AST (P = 0.048), total bilirubin (P = 0.047), fibrinogen (P = 0.022) and DD2 (P = 0.024) between the two groups. The multivariate logistic regression analysis showed that admission white blood cell count (OR = 1.153, 95% CI: 1.039-1.280, P = 0.007) was an independent risk factor for intestinal resection in patients with AMVT. The ROC curve showed that the white blood cell count (AUC = 0.759 95% CI: 0.620-0.897; P = 0.001; optimal threshold: 7.815; sensitivity: 0.881; specificity: 0.636) had good predictive value for emergency enterectomy for AMVT.
Conclusions:
Among patients with AMVT, patients with a higher white blood cell count at admission were more likely to have intestinal necrosis and require emergency enterectomy. This study is helpful for clinicians to accurately determine whether emergency intestinal resection is needed in patients with AMVT after admission, prevent further intestinal necrosis, and improve the prognosis of patients.
Insights
Higher white blood cell counts in patients with acute mesenteric vein thrombosis (AMVT) indicate a greater likelihood of intestinal necrosis requiring emergency surgery. This finding aids in timely surgical decisions for AMVT patients.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Abdominal Imaging
Background:
- Acute mesenteric vein thrombosis (AMVT) is a critical condition characterized by rapid progression and potential for extensive intestinal necrosis, often necessitating immediate surgical intervention.
- Identifying risk factors for surgical intervention in AMVT is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the risk factors associated with the need for nosocomial intestinal resection in patients diagnosed with AMVT.
Main Methods:
- A retrospective analysis of 64 patients with AMVT diagnosed via computed tomography angiography (CTA) between January 2013 and December 2021.
- Comparison of clinical and laboratory data between patients who underwent intestinal resection (n=42) and those managed conservatively (n=22).
- Statistical analysis including univariate and multivariate logistic regression, and Receiver Operating Characteristic (ROC) curve analysis.
Main Results:
- Admission white blood cell count was identified as an independent risk factor for intestinal resection in AMVT patients (OR=1.153, P=0.007).
- Univariate analysis revealed significant differences in leukocyte count, neutrophil count, AST, total bilirubin, fibrinogen, and D-dimer between the groups.
- ROC curve analysis indicated that white blood cell count has good predictive value for emergency enterectomy in AMVT (AUC=0.759, P=0.001).
Conclusions:
- Elevated white blood cell count at admission is associated with a higher risk of intestinal necrosis and the need for emergency enterectomy in AMVT patients.
- This finding can assist clinicians in making timely decisions regarding emergency intestinal resection, potentially preventing further necrosis and improving prognosis.
