Validation of a score chart to predict the risk of chronic mesenteric ischemia and development of an updated score chart

Abstract

Background and objectiveThe objective of this article is to externally validate and update a recently published score chart for chronic mesenteric ischemia (CMI).MethodsA multicenter prospective cohort analysis was conducted of 666 CMI-suspected patients referred to two Dutch specialized CMI centers. Multidisciplinary consultation resulted in expert-based consensus diagnosis after which CMI consensus patients were treated. A definitive diagnosis of CMI was established if successful treatment resulted in durable symptom relief. The absolute CMI risk was calculated and discriminative ability of the original chart was assessed by the c-statistic in the validation cohort. Thereafter the original score chart was updated based on the performance in the combined original and validation cohort with inclusion of celiac artery (CA) stenosis cause.ResultsIn 8% of low-risk patients, 39% of intermediate-risk patients and 94% of high-risk patients of the validation cohort, CMI was diagnosed. Discriminative ability of the original model was acceptable (c-statistic 0.79). The total score of the updated chart ranged from 0 to 28 points (low risk 19% absolute CMI risk, intermediate risk 45%, and high risk 92%). The discriminative ability of the updated chart was slightly better (c-statistic 0.80).ConclusionThe CMI prediction model performs and discriminates well in the validation cohort. The updated score chart has excellent discriminative ability and is useful in clinical decision making.

Mesenteric artery calcium scoring: a potential screening method for chronic mesenteric ischemia

“…A recent study reported an overall annual CMI incidence of 9.2 per 100,000 inhabitants [5]. As previously shown, this study also reported atherosclerotic CMI (7.3 per 100,000) to be the greatest contributor to the overall incidence [5][6][7]. The incidence of atherosclerotic CMI showed a rising trend over the study period, suggesting that atherosclerotic CMI is an upcoming health issue.…”

“…However, the prevalence of CVD risk factors and typical symptoms still differed significantly between CMI and non-CMI patients, suggesting that the predictive value of MACS could be improved by relating the MACS to history and clinical symptoms. Hence, the addition of the MACS to an existing CMI score chart could improve the accuracy of the predicted CMI probability and possibly prevent a missed diagnosis of CMI in patients with a non-calcified mesenteric artery stenosis [7]. Second, our inclusion strategy resulted in the inclusion of two MALS patients.…”

“…A sample size of 13 CTAs would suffice for assessment of the intraclass correlation coefficient (ICC), when comparing results of two observers, while using an alpha of 0.05 and a beta of 0.1 [18]. However, an atherosclerotic stenosis is observed in approximately 43-53% of patients [5,7]. The required sample size of 13 CTAs was tripled to 39 CTAs in order to include sufficient CTAs with calcified lesions, since interobserver variability is expected to be greater when scoring CTAs with calcifications.…”

Early risk stratification of patients with suspected chronic mesenteric ischaemia using a symptom and mesenteric artery calcium score based score chart

“…Patients not previously included in the original publication of van Dijk et al. were used to validate the score chart by van Dijk et al 8 . This score chart was applied to determine the total score of all patients (Table 1).…”

“…The indication to perform additional functional testing and ultimately the decision to treat a patient can be guided by the recently published score chart by van Dijk et al. which requires a dedicated CTA with grading of a mesenteric artery stenosis 8 . The score chart by van Dijk et al.…”