Management of acute mesenteric ischaemia: Results of a worldwide survey

Hess, Benjamin; Cahenzli, Martin; Forbes, Alastair; Burgos, R.; Coccolini, Federico; Corcos, Olivier; Holst, Mette; Irtun, Øivind; Kłęk, Stanisław; Pironi, Loris; Rasmussen, Henrik Højgaard; Serlie, Mireille J.; Thibault, Ronan; Gabe, Simon; Blaser, Annika Reintam; Akın, Emrah; Ali, Syed Muhammad; Argenio, Giulio; Atıcı, Semra Demirli; Augustin, Goran; Mpaili, Eustratia; Bains, Lovenish; Bala, Miklosh; Baldini, Edoardo; Baraket, Oussama; Barone, Mirko; Biloslavo, Alan; Bini, Roberto; Bombardini, Cristina; Brisinda, Giuseppe; Buonomo, Luis; Catena, Fausto; Ceresoli, Marco; Chiarello, Maria Michela; Chouliaras, Christos; D’Acapito, Fabrizio; Damaskos, Dimitrios; Simone, Belinda De; Delogu, Daniele; Demetrashvili, Zaza; Carlo, Isidoro Di; D’Oria, Mario; Durán-Muñoz-Cruzado, Virginia María; Forget, Patrice; Fortuna, Laura; Fransvea, Pietro; Frey, Christian; Gapejeva, Olga; Garçon, Pierre; Gass, Jörn‐Markus; Gonsaga, Ricardo Alessandro Teixeira; Griffiths, Ewen; Gündoğan, Kürşat; Gurjar, Mohan; Hamid, Hytham K. S.; Jiménez, Juan Ignacio Silesky; Kase, Karri; Kazmi, Syed Sajid Hussain; Kechagias, Aristotelis; Khokha, Vladimir; Kobe, Yoshiro; Korkolis, Dimitrios; Litvin, Andrey; Lostoridis, Eftychios; Mahendran, Hans Alexander; Marino, Fabio; Martinuzzi, Andrés; Meşină, Cristian; Neri, Vincenzo; Panišić, Marina; Paolillo, Ciro; Παραράς, Νικόλαος; Perrone, Gennaro; Pesce, Antonio; Picardi, Biagio; Pither, C; Podda, Mauro; Poskus, Tomas; Poullenot, Florian; Przemyslaw, Matras; Sartelli, Massimo; Sasia, Diego; Scheiterle, M.; Seretis, Fotios; Søreide, Kjetil; Sydorchuk, Ruslan; Szczepanek, Kinga; Bodnár, Zsolt; Tamion, Fabienne; Tarasconi, Antonio; Teraa, Martin; Tolonen, Matti; Vanuytsel, Tim; Veroux, Massimiliano; Vinter‐Jensen, Lars; Visconti, Diego; Widmer, Lukas A.; Zakaria, Andee Dzulkarnaen; Зубарева, Н А; Societies, Endorsing International; ESICM,; WSES,; WSACS,; support, In-principle; WFICC,

doi:10.1016/j.clnesp.2022.12.022

Cited by 10 publications

(3 citation statements)

References 22 publications

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“…Мікробіологічні дослідження хворих на гострі гнійно-запальні захворювання сечовидільної системи вказують на відсутність специфічного збудника захворювання [11,12]. Повідомляється, що найчастіше збудниками є представники автохтонної факультативної флорикишкові мікроорганізми, зокрема умовно патогенні ентеробактерії та різноманітні коки [8,13,14].…”

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Microflora of the Urogenital Tract in Acute Purulentinflammatory Diseases of the Urinary System as a Prerequisite of Abdominal Sepsis

Petelytskyi,

Tkachuk,

Stepan

et al. 2024

Clin. and experim. pathol.

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The aim – to ascertain the etiological role of various taxonomic groups of autochthonousand allochthonous microorganisms in the origin of acute purulent- inflammatory diseasesof the urinary system as a prerequisite of abdominal sepsis.Materials and methods. The study covers 145 patients with acute purulent- inflammatorydiseases of the urinary system. When studying the microbiota of the urinary system,standard microbiological methods were used, the number of colony- forming units(CFU) was counted, determining the population level of each species or group of themicroorganisms, the obtained numerical values were converted into a decimal logarithm(lg CFU). The etiopathogenetic value of individual representatives of the microbiotawas assessed by the constancy index, frequency and significance indicators, as well asthe coefficient of quantitative dominance of each type of microorganisms, and otherindicators (Margalef index, Berger- Parker dominance index).Results. Acute purulent- inflammatory diseases of the urinary system are polyetiologicaldiseases caused by microorganisms belonging to different taxonomic groups. The leadingrole belongs to opportunistic Escherichia, to a lesser extent enteropathogenic E.coli,as well as conditionally pathogenic Staphylococci, in addition to that only in a small(13.48 %) number of patients it was not possible to isolate and identify the pathogens.Associations of pathogens were often encountered, which testifies to the need of developingan antimicrobial effect on etiological factors. Conclusions. Acute purulent- inflammatory diseases of the urinary system arecharacterized by polyetiological factors, a variety of pathogens with the dominant roleof Escherichia coli and Staphylococci. The identified pathogens create the potentialfor translocation and formation, under certain conditions, of abdominal sepsis in thiscontingent of patients.

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Section: вступunclassified

Microflora of the Urogenital Tract in Acute Purulentinflammatory Diseases of the Urinary System as a Prerequisite of Abdominal Sepsis

Petelytskyi,

Tkachuk,

Stepan

et al. 2024

Clin. and experim. pathol.

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“…Regardless of the specific approaches to diagnosis and management for different subtypes of AMI, all subtypes ultimately lead to severe consequences and high mortality [ 1 , 2 ]. A recent survey has identified delay in diagnosis of AMI and heterogeneity in management approaches as contributing to poor outcomes [ 8 ]. Recent guidelines accentuate the importance of computed tomography angiography being performed in all patients with suspected AMI, immediate surgical treatment in patients with overt peritonitis, and emphasize revascularization in cases of occlusive arterial AMI, whereas there is more uncertainty regarding other recommendations [ 9 , 10 ].…”

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confidence: 99%

Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study)

Reintam Blaser,

Mändul,

Björck

et al. 2024

Crit Care

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Background The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI). Methods All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected. Results AMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1–12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied. Conclusions The overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management. Trial registration: NCT05218863 (registered 19.01.2022).

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“…emergency care physicians, vascular surgeons, interventional radiologists, visceral surgeons, gastroenterologists, intensivists), potentially complicating a uniform approach. A recent survey distributed amongst different medical specialists individually as well as in teams within different hospitals demonstrated that diagnosis of AMI is often delayed and that management is widely variable [ 2 ]. It has been shown that improved awareness (clinical suspicion) and focusing on the problem may improve outcomes [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis

Reintam Blaser,

Starkopf,

Björck

et al. 2023

World J Emerg Surg

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Background Acute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans. Methods A systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers’ sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool. Results Seventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses. Conclusions None of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.

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Management of acute mesenteric ischaemia: Results of a worldwide survey

Cited by 10 publications

References 22 publications

Microflora of the Urogenital Tract in Acute Purulentinflammatory Diseases of the Urinary System as a Prerequisite of Abdominal Sepsis

Microflora of the Urogenital Tract in Acute Purulentinflammatory Diseases of the Urinary System as a Prerequisite of Abdominal Sepsis

Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study)

Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis

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