Risk Factors for Acute Mesenteric Ischemia in Critically Ill Burns Patients—A Matched Case–Control Study

Soussi, Sabri; Taccori, Marina; Tymowski, Christian de; Dépret, François; Chaussard, Maïté; Fratani, Alexandre; Jully, Marion; Cupaciu, Alexandru; Ferry, Axelle; Benyamina, Mourad; Serror, Kévin; Boccara, David; Chaouat, Marc; Mimoun, Maurice; Cattan, Pierre; Zagdanski, Anne–Marie; Anstey, James; Mebazaa, Alexandre; Legrand, Matthieu

doi:10.1097/shk.0000000000001140

Cited by 23 publications

(32 citation statements)

References 30 publications

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“…The 28-day mortality in our series was very high (75% in the entire cohort), which is consistent with a recent study describing 90-day mortality rates of up to 90%. 4 Previous case series describing the employment of a local intra-arterial prostaglandin application included 3 to 9 patients. [47][48][49][50] The so far largest case series of 9 patients included almost exclusively patients who had undergone cardiovascular surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Consistently, it has been reported recently that reduced cardiac output and a high SOFA score were independent predictors for the emergence of NOMI. 4 …”

Section: Discussionmentioning

confidence: 99%

“… 2 Mortality ranges between 50% and 93%. 3 , 4 Case reports and small retrospective case series described the occurrence of NOMI especially after cardiac surgery 5 – 10 and heart failure 6 , 11 but also in a variety of other acute critical illnesses. 11 – 24…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

Stahl

Busch

Maschke

et al. 2019

J Intensive Care Med

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Background: To analyze demography, clinical signs, and survival of intensive care patients diagnosed with nonocclusive mesenteric ischemia (NOMI) and to evaluate the effect of a local intra-arterial prostaglandin therapy. Methods: Retrospective observational study screening 455 intensive care patients with acute arterial mesenteric perfusion disorder in a tertiary care hospital within the past 8 years. Lastly, 32 patients with NOMI were enrolled, of which 11 received local intra-arterial prostaglandin therapy. The diagnosis of NOMI was based on the clinical presentation and established biphasic computed tomography criteria. Clinical and biochemical data were obtained 24 hours before, at the time, and 24 hours after diagnosis. Results: Patients were 60.5 (49.3-73) years old and had multiple comorbidities. Most of them were diagnosed with septic shock requiring high doses of norepinephrine (NE: 0.382 [0.249-0.627] μg/kg/min). The Sequential Organ Failure Assessment (SOFA) score was 18 (16-20). A decrease in oxygenation (Pao2/Fio2), pH, and bicarbonate and an increase in international normalized ratio, lactate, bilirubin, leucocyte count, and NE dose were early indicators of NOMI. Median SOFA score significantly increased in the last 24 hours before diagnosis of NOMI (16 vs 18, P < .0001). Overall, 28-day mortality was 75% (81% nonintervention vs 64% intervention cohort; P = .579). Median SOFA scores 24 hours after intervention increased by +5% in the nonintervention group and decreased by 5.5% in the intervention group ( P = .0059). Conclusions: Our data suggest that NOMI is a detrimental disease associated with progressive organ failure and a high mortality. Local intra-arterial prostaglandin application might hold promise as a rescue treatment strategy. These data encourage future randomized controlled trials are desirable.

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Section: Discussionmentioning

confidence: 99%

“…Consistently, it has been reported recently that reduced cardiac output and a high SOFA score were independent predictors for the emergence of NOMI. 4 …”

Section: Discussionmentioning

confidence: 99%

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A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

Stahl

Busch

Maschke

et al. 2019

J Intensive Care Med

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“…Severe burn injury is associated with an early and profound hypovolemia followed by an intense systemic inflammatory response. Hemodynamic management, including fluid resuscitation, has long been recognized as the cornerstone of the early management and hemodynamic resuscitation of severely burned patients [1][2][3]. However, a systemic inflammatory response may be associated with distributive shock and/or acute myocardial dysfunction [4].…”

Section: Introductionmentioning

confidence: 99%

Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure, acute kidney injury and death in severely ill burn patients

et al. 2020

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Background: Dipeptidyl peptidase-3 (DPP3) is a metallopeptidase which cleaves bioactive peptides, notably angiotensin II, and is involved in inflammation regulation. DPP3 has been proposed to be a myocardial depressant factor and to be involved in circulatory failure in acute illnesses, possibly due to angiotensin II cleavage. In this study, we evaluated the association between plasmatic DPP3 level and outcome (mortality and hemodynamic failure) in severely ill burn patients. Methods: In this biomarker analysis of a prospective cohort study, we included severely ill adult burn patients in two tertiary burn intensive care units. DPP3 was measured at admission (DPP3 admin) and 3 days after. The primary endpoint was 90-day mortality. Secondary endpoints were hemodynamic failure and acute kidney injury (AKI). Results: One hundred and eleven consecutive patients were enrolled. The median age was 48 (32.5-63) years, with a median total body surface area burned of 35% (25-53.5) and Abbreviated Burn Severity Index (ABSI) of 8 (7-11). Ninety-day mortality was 32%. The median DPP3 admin was significantly higher in non-survivors versus survivors (53.3 ng/mL [IQR 28.8-103.5] versus 27.1 ng/mL [IQR 19.4-38.9]; p < 0.0001). Patients with a sustained elevated DPP3 had an increased risk of death compared to patients with high DPP3 admin but decreased levels on day 3. Patients with circulatory failure had higher DPP3 admin (39.2 ng/mL [IQR 25.9-76.1] versus 28.4 ng/mL [IQR 19.8-39.6]; p = 0.001) as well as patients with AKI (49.7 ng/mL [IQR 30.3-87.3] versus 27.6 ng/mL [IQR 19.4-41.4]; p = 0.001). DPP3 admin added prognostic value on top of ABSI (added chi 2 12.2, p = 0.0005), Sequential Organ Failure Assessment (SOFA) score at admission (added chi 2 4.9, p = 0.0268), and plasma lactate at admission (added chi 2 6.9, p = 0.0086) to predict circulatory failure within the first 48 h.

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“…Risk factors for NOMI include cardiovascular and chronic kidney disease, administration of vasoconstrictive medications or drugs (e.g., digoxin, vasopressor therapy, cocaine, methamphetamine abuse), recent major surgery, sepsis, and shock [3,4]. Overall, NOMI accounts for 5-15% of acute mesenteric ischemia cases [2,3] and is associated with high mortality rates ranging between 50 and 93%, primarily due to its association with severe comorbidities [3,5,6]. Contrary to well-known symptoms of acute occlusive arterial mesenteric ischemia, clinical signs of NOMI are often unspecific [3,4,7].…”

Section: Introductionmentioning

confidence: 99%

Non-occlusive mesenteric ischemia (NOMI): evaluation of 2D-perfusion angiography (2D-PA) for early treatment response assessment

et al. 2020

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Purpose To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI). Methods Overall, 20 procedures in 18 NOMI patients were included in this retrospective case-control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed. Regions of interest (ROIs) were placed in the superior mesenteric artery (SMA; reference), the portal vein (PV; ROI PV), as well as the aorta next to the origin of the SMA (ROI Aorta). Peak density (PD), time to peak (TTP), and area under the curve (AUC) were assessed, and parametric ratios 'target ROI PD, TTP, AUC /reference ROI' were computed and compared within treatment and control group. Additionally, a NOMI score was assessed pre-and post-treatment compared to 2D-PA. Results Vasodilator therapy leads to a significant decrease of the 2D-PA-derived values PD Aorta (p = 0.04) and AUC Aorta (p = 0.03). These findings correlated with changes of the simplified NOMI score, both for overall (4 to 1, p < 0.0001) and for each category. Prostaglandin application caused a significant increase of the AUC PV (p = 0.04) and TTP PV was accelerated without reaching statistical significance (p = 0.13). When compared to a control group, all 2D-PA values in the NOMI group (pre-and post-intervention) differed significantly (p < 0.05) with longer TTP Aorta/PV and lower AUC Aorta/PV and PD Aorta/PV. Conclusion 2D-PA offers an objective approach to analyze immediate flow and perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable tool for assessing treatment response.

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Risk Factors for Acute Mesenteric Ischemia in Critically Ill Burns Patients—A Matched Case–Control Study

Abstract: Burns patients with initial low cardiac output and early multiple organ dysfunction are at high risk of non-occlusive AMI.

Cited by 23 publications

References 30 publications

A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure, acute kidney injury and death in severely ill burn patients

Non-occlusive mesenteric ischemia (NOMI): evaluation of 2D-perfusion angiography (2D-PA) for early treatment response assessment

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