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Updated: Jun 30, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery
Francois Stephan1, Mathilde Facque2, Fares Ben Salem3
1Paris Saclay University, School of Medicine, Le Kremlin Bicetre, France.
Insights
Diagnosing gastrointestinal ischemia after cardiothoracic surgery is difficult. A new scoring system combining computed tomography angiography (CTA) findings with other clinical variables improves diagnostic accuracy for this condition.
Area of Science:
- Cardiovascular Surgery
- Gastrointestinal Medicine
- Radiology
Background:
- Gastrointestinal ischemia (GIisch) diagnosis is challenging post-cardiothoracic surgery.
- Computed tomography angiography (CTA) has limitations, including high false-negative and false-positive rates.
- Improved diagnostic methods are needed for GIisch in this patient population.
Purpose of the Study:
- To evaluate if combining readily available variables with CTA findings improves GIisch diagnosis.
- To develop and validate a GIisch prediction score for post-cardiothoracic surgery patients.
Main Methods:
- Retrospective study of intensive care patients post-cardiothoracic surgery.
- GIisch confirmed by surgical/endoscopic findings.
- Developed a GIisch prediction score using the Spiegelhalter-Knill-Jones system in a training cohort and validated it.
Main Results:
- The developed score incorporated cardiopulmonary bypass, intraoperative mean arterial pressure, AST levels, lactate increase, and CTA findings (bowel dilation, wall thickening, mesenteric vasoconstriction).
- The score demonstrated good diagnostic performance with an area under the receiver operating characteristic curve of 0.82 in both training and validation cohorts.
- Reliable probability predictions were achieved for probabilities ≤ 30% or ≥ 70%.
Conclusions:
- CTA findings alone are insufficient to rule out GIisch in post-cardiothoracic surgery patients.
- A scoring system integrating CTA findings with other clinical variables enhances GIisch diagnosis in this critical care setting.
Background:
Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery.
Methods:
This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA).
Results:
The training cohort comprised 125 consecutive patients with suspected GIisch in 2008 to 2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure < 50 mm Hg, aspartate aminotransferase > 15 N, lactate increase in 24 hour > 20%, and 3 CTA findings, namely, bowel dilation, bowel wall thickening, and mesenteric vasoconstriction. The area under the receiver operating characteristic was 0.82 (95% confidence interval [CI], 0.51-0.93) in the training cohort and 0.82 (95% CI, 0.68-0.96) in the validation cohort (n = 34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤ 30% or ≥ 70%.
Conclusion:
In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population.
