Background
To study the mortality and delays of management of patients with acute mesenteric
ischemia (AMI) admitted to the emergency department of a tertiary hospital and identify
risk factors for 1-month mortality.
Methods
A single-center and retrospective study including all consecutive patients treated
for AMI from January 2008 to December 2018 was conducted. Short- and medium-term survival
was studied with a Kaplan-Meier analysis. Delays before diagnosis and surgical intervention
were collected. To determine factors associated with mortality at 1 month postoperatively,
univariate and multivariate analyzes were performed.
Results
The survival rate of the 67 included patients was 55.22% at 1 month and 37.31% at
1 year. In-hospital mortality was 50.74%. The average delay between admission and
diagnosis was 4.83 ± 5.03 hr (95% confidence interval [CI], 3.60–6.05), and the delay
between admission and surgical treatment was 10.64 ± 8.80 hr (95% CI, 8.49–12.79).
The independent variables associated with an increased mortality at 1 month postoperatively
in the univariate analysis were age >65 years old (odds ratio [OR] = 3.52; P = 0.046), lactate >3.31 mmol/l at admission (H0) (OR = 7.38; P < 0.001), lactate >3.32 mmol/l on day 1 (H24) (OR = 5.60; P = 0.002), creatinine >95.9 μmol/l at H0 (OR = 4.66; P = 0.004), aspartate aminotransferase (AST) >59 U/l at H0 (OR = 3.55; P = 0.017), and having hypertension as comorbidity (OR = 9.32; P = 0.040). Early curative anticoagulation (z = −2.4; P = 0.016) was an independent protective factor for mortality, and lactate >3.31 mmol/l
at H0 (z = 2.62; P = 0.009) was an independent predictor factor of mortality at 1 month postoperatively
in the multivariate analysis.
Conclusion
AMI remains a serious and lethal condition with delays of surgical management remaining
too long due to a lack of a dedicated therapeutic protocol allowing an early diagnosis.
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Article info
Publication history
Published online: December 19, 2022
Accepted:
December 6,
2022
Received:
September 25,
2022
Footnotes
Funding: None.
Disclosure: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
