Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia

Abstract

Background The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI. Methods Patients with bowel ischemia were identified by searching for “ICD-10 code K550” in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled. Results Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096–0.58). Conclusions The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy.

Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia: A multicenter retrospective cohort study

“…Toda et al . 30 reported that a SOFA score less than 3 and several biological markers (serum levels of albumin, total bilirubin, lactate dehydrogenase, and C-reactive protein) may help determine a treatment plan for NOMI and avoid unnecessary laparotomies. In our study, 11 patients with a SOFA score less than 3 underwent exploratory laparotomies, and all required surgery.…”

Spontaneous pneumoperitoneum and diabetic ketoacidosis in fulminant type 1 diabetes: a case report

“…In this case, the pneumoperitoneum improved with careful follow-up without surgery. No reports have indicated the criteria for selecting between conservative and surgical treatment for pneumoperitoneum; however, a low sequential organ failure assessment (SOFA) score (≤ 3 points) is reportedly a useful indicator for conservative treatment in NOMI cases [ 10 ]. In our case, although it is unclear whether the pneumoperitoneum was due to NOMI, the SOFA score was 1 point, indicating that conservative treatment was appropriate.…”

Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia

“…Therefore, further study is needed. Fourth, the quick Sepsis-related Organ Failure Assessment (qSOFA) score, with a cutoff value ≤ 3, was found to be a reliable predictor of survival in NOMI patients treated with conservative management[ 33 ]. We did not analyze the qSOFA score in the present work, and further study of the prognostic value of the qSOFA score in NOMI patients treated with surgery is needed.…”