Predictors of Acute Transmural Intestinal Necrosis in Acute Mesenteric Ischemia: A Single-center Retrospective Study

Abstract

Introduction: Acute mesenteric ischemia (AMI) is a rare life-threatening condition, especially for the patients with intestinal transmural necrosis. However, the optimal time of surgical intervention was controversial. As a series study, the current study aimed to identify the predictors for transmural intestinal necrosis (TIN) facilitating the decision making in patients with AMI. Methods: Records of patients with AMI in the period of January 2010 to January 2017 were reviewed in a national gastrointestinal referral center in China. The data of patients including clinical parameters, laboratory examinations and radiologic investigations were analyzed to identify predictors for TIN using binary logistic regression analysis. Results: A total of 158 patients (108 (68.4%) men; median age 59 (50-67) years) were included. The types of AMI were 32.9% in arterial and 67.1% in venous cases. According to the results of pathological assessment and follow-up, sixty-one patients completed conservative treatment successfully, whereas 97 patients required exploratory laparotomy. On laparotomy, superficial ischemic lesions were seen in 8 patients, and intestinal stricture were identified in 27 patients. Overall, 62 were TIN and 96 patients were non-TIN. The 1-year mortality for TIN versus non-TIN was 29% and 2.1%, with an overall mortality of 12.7%. The significant independent predictors for TIN were procalcitonin >0.5ug/L (OR: 3.752(1.619∼8.639); P=0.002), free intraperitoneal fluid (OR: 4.178(1.753∼9.954); P=0.001) and pneumatosis intestinalis (OR: 8.184(3.203∼20.909); P< 0.001) on CT imaging. Area under the receiver operating characteristics curve for the diagnosis of TIN was 0.844 (95% CI: 0.777-0.910) depending on the number of predictive factors. Conclusion: Patients with transmural intestinal necrosis had a significant high mortality rate (above 10-fold) for AMI. We identified the independent predictors for TIN were procalcitonin >0.5ug/L, free intraperitoneal fluid and pneumatosis intestinalis on CT imaging.Close monitoring could help discriminate AMI patients developed transmural intestinal necrosis and in urgent need for bowel resection from those who can be managed with conservative measures. Disclosure: Nothing to disclose