Prognostic Factors in Non-occlusive mesenteric ischemia: A pragmatic pre-operative score for the prediction of 28-day mortality - 20/06/22
, Hadrien Winiszewski c, Zaher Lakkis d, Pierre Verdot a, Sebastien Pili-Floury e, Bruno Heyd d, Gael Piton c, Eric Delabrousse a, e, Alexandre Doussot dAbstract |
Background |
The prognosis of critical ill patients with non-occlusive mesenteric ischemia (NOMI) is poor and not fully understood. We aimed to determine preoperative factors associated with 28-day mortality in NOMI.
Methods |
Variables associated with 28-day mortality were entered into a multivariate cox regression model and were used to compute a NOMI mortality score.
Results |
154 patients were included. The 28-day mortality rate was 56%. Multivariable analyses including variables at the time of the CT identified three variables (i.e. lactates > 7 mmoL/l, prothrombin rate <60% and kidney infarction), included in a simple score. Among the study population, the probability of 28-day mortality was 26% (11/42), 54% (26/48), 77% (23/30) and 100% (21/21) for a survival score of 0, 1, 2 and 3, respectively.
Conclusion |
A simple score combining these three variables, calculated preoperatively, was able to accurately predict 28-day mortality and might help to avoid futile laparotomies.
Le texte complet de cet article est disponible en PDF.Highlights |
• | In our retrospective cohort of ICU patients with NOMI who underwent laparotomy, we observed a 28-day mortality rate of 56%. |
• | A simple preoperative score combining lactates >7 mmol/L, prothrombin rate <60% and kidney infarction on CT could accurately predict 28-day mortality. |
• | Jejunal transmural necrosis was the only operative finding associated with 28-day mortality (HR = 2.26 CI95%[1.14–4.71], P = 0.019). |
Keywords : Non-occlusive mesenteric ischemia, Critical care, Computed tomography, Small bowel, Prognosis
Abbreviations : AMI, AUROC, AST, CT, CI, ICU, IQR, HR, NOMI, OMI, SMA
Plan
Vol 224 - N° 1PB
P. 617-623 - juillet 2022 Retour au numéro
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