Mortality and Delays of Management of Acute Mesenteric Ischemia: The Need of a Dedicated Program

Abstract

To study the mortality and delays of management of patients with acute mesenteric ischemia (AMI) admitted to the emergency department of a tertiary hospital and identify risk factors for 1-month mortality. A single-center and retrospective study including all consecutive patients treated for AMI from January 2008 to December 2018 was conducted. Short- and medium-term survival was studied with a Kaplan-Meier analysis. Delays before diagnosis and surgical intervention were collected. To determine factors associated with mortality at 1month postoperatively, univariate and multivariate analyzes were performed. The survival rate of the 67 included patients was 55.22% at 1month and 37.31% at 1year. In-hospital mortality was 50.74%. The average delay between admission and diagnosis was 4.83±5.03hr (95% confidence interval [CI], 3.60-6.05), and the delay between admission and surgical treatment was 10.64±8.80hr (95% CI, 8.49-12.79). The independent variables associated with an increased mortality at 1month postoperatively in the univariate analysis were age >65years old (odds ratio [OR]=3.52; P=0.046), lactate >3.31mmol/l at admission (H0) (OR=7.38; P< 0.001), lactate >3.32mmol/l on day 1 (H24) (OR=5.60; P=0.002), creatinine >95.9μmol/l at H0 (OR=4.66; P=0.004), aspartate aminotransferase (AST)>59 U/l at H0 (OR=3.55; P=0.017), and having hypertension as comorbidity (OR=9.32; P=0.040). Early curative anticoagulation (z=-2.4; P=0.016) was an independent protective factor for mortality, and lactate >3.31mmol/l at H0 (z=2.62; P=0.009) was an independent predictor factor of mortality at 1month postoperatively in the multivariate analysis. AMI remains a serious and lethal condition with delays of surgical management remaining too long due to a lack of a dedicated therapeutic protocol allowing an early diagnosis.