Prognostic Factors of Preoperative Examinations for Non‐occlusive Mesenteric Ischemia: A Multicenter Retrospective Project Study Conducted by the Japanese Society for Abdominal Emergency Medicine

Abstract

Background Non-occlusive mesenteric ischemia (NOMI) has a high mortality rate, but the analyses of preoperative prognostic factors for improving survival in patients suspected of having NOMI are scarce. We aimed to analyze the prognostic factors of preoperative examinations for NOMI. Methods The clinical data of 224 patients with NOMI were retrospectively collected for a multicenter survey. Clinicophysiological factors were compared between the survivors and non-survivors (N = 107/117) and between the operative and non-operative cases (N = 180/44) by univariate analysis using chi-square test and multivariate analysis using Cox proportional hazard models. In the operative cases, the prognostic operative factors were also analyzed. ResultsThe overall mortality rate for NOMI was 52.2%. There were 129 male and 95 female patients. The mean age was 71.23 (14-94) years. Univariate analysis showed that cardiovascular complication, shock, abdominal pain, average blood pressure, systemic inflammatory response syndrome, aspartic aminotransferase, alanine transaminase, creatine phosphokinase, lactate dehydrogenase, base excess, prothrombin time-international normalized ratio, D-dimer, and fibrinogen degradation products were independent prognostic factors. Multivariate analysis showed that average blood pressure and base excess were independent prognostic factors. Among patients undergoing surgery, those with bowel resection had better prognosis than those without bowel resection, but those with long bowel resection had worse prognosis than those with short resection. Additional postoperative treatment was not effective compared with operation alone (P = 0.011). Conclusions Prognostic factors of preoperative examinations for NOMI were average blood pressure and base excess. Patients with long bowel resection should be carefully monitored owing to their poor prognosis.

Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia

“…While emergency laparotomy for suspected MOMI has been recommended, the clinical outcomes have not improved as we expected [6][7][8][9]. Indeed, it is di cult to determine an appropriate bowel resection line by intraoperative ndings due to the potentially multifocal and progressive nature of the ischemic disease.…”

“…There have been several studies to evaluate risk factors for the development of NOMI and factors in uencing the surgical outcomes [6][7][8][9]. However, the criteria for the decision of non-operative management remain poorly de ned.…”

Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia

“…Meanwhile, there is a spectrum of severity, from mild mucosal ischemia to transmural bowel necrosis and perforation, in the manifestation of NOMI [ 3 ]. Some previous studies showed successful outcomes of conservative treatment for the initial stages, with limited bowel wall ischemia [ 8 , 12 ]. Nonetheless, the decision-making of conservative treatment for NOMI is challenging.…”

Prognostic Factors in Non-Occlusive Mesenteric Ischemia: A Pragmatic Pre-Operative Score for the Prediction of 28-day Mortality

“…Acute mesenteric ischemia (AMI) is a life-threatening condition associated with high mortality, ranging from 20 to 77% [1][2][3][4][5][6][7] . However, the different mechanisms leading to AMI do not share the same prognosis.…”

“…Although the two diseases are very different from a pathophysiological point of view, most of the previously published studies examining the prognosis of AMI have included both OMI and NOMI [1][2][3] . Furthermore, among the studies focused on NOMI 4,6 , a substantial proportion of patients did not undergo laparotomy, resulting in a potential bias in predicting prognosis, since the de nition of NOMI is neither standardized nor consensual.…”