Multivariate analysis of intestinal necrosis in acute superior mesenteric artery embolism: a single institution experience

Abstract

BackgroundAcute superior mesenteric artery embolism (ASMAE), a subtype of acute mesenteric ischemia, presents a diagnostic challenge owing to its nonspecific clinical presentation and laboratory data, which makes early detection of this condition difficult. Delays in diagnosis lead to intestinal mucosal necrosis, a serious and potentially life-threatening condition. Therefore, the predictors of early intestinal necrosis in patients with ASMAE must be explored. This study aimed to determine predictors for early intestinal necrosis in patients with ASMAE using multivariate logistic regression analysis. Materials and methodsThis was retrospective study involving 71 ASMAE patients who were treated at Dalian Central Hospital in China from January 2010 to January 2022. Patients were categorized into two groups; those with intestinal necrosis and those without intestinal necrosis. Comparisons of patient demographic characteristics, clinical presentation, laboratory tests, and computed tomography angiography (CTA) features were performed between ASMAE patients with and without intestinal necrosis. ResultsA total of 71 patients with a male to female ratio of 1.4: 1 were studied. Their mean age at diagnosis was 70.2 ± 12.3 years (43 to 86 years). Out of 71 patients, 40(56.3%) presented with intestinal necrosis, and 31(43.7%) patients had no intestinal necrosis. According to multivariate logistic regression analysis, decreased bowel sound (OR: 1.7. 95%CI (1.0-25.1); p =0.033), prolonged time of onset (OR: 4.2. 95%CI (2.0-88.8) p= 0.041); elevated WBC count (OR: 3.9; 95%CI [3.5-47.7]; p=0.002), decreased bowel wall enhancement (p < 0.001) and bowel thickening (OR; 2.1; 95% CI [1.5-9.8]; p= 0.011) were found to be independent predictors of intestinal necrosis in ASMAE patients. In this study, sixteen patients died, giving a mortality rate of 22.5%. ConclusionThis study demonstrated that decreased bowel sounds, prolonged time of onset, elevated WBC count, decreased bowel wall enhancement, and bowel thickening were found to be strong predictors of early intestinal necrosis in ASMAE patients. A multi-center prospective study with a larger sample size needs to be performed to investigate these findings further.