R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland 21201, USA.
J Trauma Acute Care Surg. 2013 Jul;75(1):15-23. doi: 10.1097/TA.0b013e318298486e.
Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life threatening. To date, series of PI outcomes consist of case reports and small retrospective series.
We conducted a retrospective multicenter study, involving eight centers, of PI from January 2001 to December 2010. Demographics, medical history, clinical presentation, and outcomes were collected. Primary outcome was the presence of pathologic PI defined as confirmed transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression and a regression tree analysis was used to generate a clinical prediction rule for pathologic PI.
During the 10-year study period, 500 patients with PI were identified. Of this number, 299 (60%) had benign disease, and 201 (40%) had pathologic PI. A wide variety of variables were statistically significant predictors of pathologic PI on univariate comparison. In the regression model, a lactate of 2.0 or greater was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation, and absent bowel sounds also demonstrating significance. Classification and regression tree analysis was used to create a clinical prediction rule. In this tree, the presence of a lactate value of 2.0 or greater and hypotension/vasopressor use had a predictive probability of 93.2%.
Discerning the clinical significance of PI remains a challenge. We identified the independent predictors of pathologic PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted.
Epidemiologic study, level III.
肠气肿（PI）与许多成人疾病有关，从良性到危及生命不等。迄今为止，PI 的结果系列包括病例报告和小回顾性系列。
我们进行了一项回顾性多中心研究，涉及 2001 年 1 月至 2010 年 12 月的 8 个中心的 PI。收集了人口统计学、病史、临床表现和结果。主要结果是存在病理性 PI，定义为手术证实的穿透性缺血或停止临床治疗和随后的死亡率。使用向前逻辑回归和回归树分析生成病理性 PI 的临床预测规则。
在 10 年的研究期间，确定了 500 例 PI 患者。其中，299 例（60%）患有良性疾病，201 例（40%）患有病理性 PI。在单变量比较中，许多变量都是病理性 PI 的统计学显著预测因素。在回归模型中，2.0 或更高的乳酸是病理性 PI 的最强独立预测因素，低血压或血管加压素需求、腹膜炎、急性肾衰竭、有创机械通气和肠鸣音消失也具有显著意义。分类和回归树分析用于创建临床预测规则。在该树中，2.0 或更高的乳酸值和低血压/血管加压素使用的存在具有 93.2%的预测概率。
辨别 PI 的临床意义仍然是一个挑战。我们确定了迄今为止最大人群中病理性 PI 的独立预测因素，并为临床应用开发了基本预测模型。需要前瞻性验证。
流行病学研究，III 级。
