Pneumatosis Intestinalis and Porto-Mesenteric Venous Gas: A Multicentre Study

Abstract

Background: Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine. Results: A total 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis). Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p<0.001). In the entire patient group, 53.5% (155/290) were treated surgically. OS was >90d in 25% (72/90) of conservatively treated patients. In these cases PMVG/PI and was defined as “benign”/reversible. PMVG, COPD, sepsis, and low platelet count correlated with a worse prognosis. To identify patients deteriorating despite surgery, our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV. Conclusion: Although PI is associated with high morbidity and mortality, „benign causes” are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.