Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.
Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Medical Center, Homburg, Germany.
Crit Care Med. 2018 Jun;46(6):e575-e583. doi: 10.1097/CCM.0000000000003091.
To prospectively evaluate the relationship of established inflammatory markers and presepsin on nonocclusive mesenteric ischemia and to correlate presepsin levels to the occurrence and severity of nonocclusive mesenteric ischemia.
Patients were prospectively enrolled and blood samples taken, followed by a retrospective evaluation of laboratory values and angiographic findings. The study was ethics committee approved.
Patients with clinical suspicion of nonocclusive mesenteric ischemia underwent catheter angiography of the superior mesenteric artery. Images were assessed by two experienced radiologists on consensus basis using a previously published standardized reporting system (Homburg-Nonocclusive Mesenteric Ischemia-Score). Two groups were formed according to the severity of nonocclusive mesenteric ischemia, mild and severe, patients without clinical signs of nonocclusive mesenteric ischemia formed the reference group. These data were correlated to inflammatory blood markers assessed pre- and postoperatively: C-reactive protein, leucocytes, procalcitonin, and presepsin as well as outcome data.
Between January 2010 and March 2011, a total of 839 patients undergoing cardiovascular surgery participated in this study.
Mild nonocclusive mesenteric ischemia was diagnosed in 4.5%, and severe nonocclusive mesenteric ischemia in 3.2%. Median postoperative presepsin concentrations were significantly greater in mild and severe nonocclusive mesenteric ischemia than in non-nonocclusive mesenteric ischemia. Statistics showed that postoperative presepsin better discriminated mild and severe nonocclusive mesenteric ischemia than any other tested biomarker.
Elevated postoperative plasma presepsin concentrations are an independent predictor of mild and severe nonocclusive mesenteric ischemia. The established inflammatory blood markers significantly correlate with the development and severity of nonocclusive mesenteric ischemia.
前瞻性评估已建立的炎症标志物和降钙素原前肽与非闭塞性肠系膜缺血的关系，并将降钙素原前肽水平与非闭塞性肠系膜缺血的发生和严重程度相关联。
前瞻性入组患者并采集血样，然后对实验室值和血管造影结果进行回顾性评估。该研究获得伦理委员会批准。
临床疑似非闭塞性肠系膜缺血的患者接受肠系膜上动脉导管造影。图像由两名有经验的放射科医生根据共识使用先前发表的标准化报告系统（Homburg-非闭塞性肠系膜缺血评分）进行评估。根据非闭塞性肠系膜缺血的严重程度将患者分为两组，轻度和重度，无非闭塞性肠系膜缺血临床症状的患者形成对照组。将这些数据与术前和术后评估的炎症血液标志物（C 反应蛋白、白细胞、降钙素原和降钙素原前肽）以及预后数据相关联。
2010 年 1 月至 2011 年 3 月，共有 839 例行心血管手术的患者参与了这项研究。
4.5%的患者诊断为轻度非闭塞性肠系膜缺血，3.2%的患者诊断为重度非闭塞性肠系膜缺血。与非非闭塞性肠系膜缺血相比，轻度和重度非闭塞性肠系膜缺血患者术后降钙素原前肽浓度中位数明显更高。统计学显示，术后降钙素原前肽比任何其他测试的生物标志物更好地区分轻度和重度非闭塞性肠系膜缺血。
升高的术后血浆降钙素原前肽浓度是轻度和重度非闭塞性肠系膜缺血的独立预测因子。已建立的炎症血液标志物与非闭塞性肠系膜缺血的发生和严重程度显著相关。
