Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, Besançon, France.
EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
Am J Gastroenterol. 2021 Jul 1;116(7):1506-1513. doi: 10.14309/ajg.0000000000001274.
To identify factors associated with irreversible transmural necrosis (ITN) among critically ill patients experiencing nonocclusive mesenteric ischemia (NOMI) and to compare the predictive value regarding ITN risk stratification with that of the previously described Clichy score.
All consecutive patients admitted to the intensive care unit between 2009 and 2019 who underwent exploratory laparotomy for NOMI and who had an available contrast-enhanced computed tomography with at least 1 portal venous phase were evaluated for inclusion. Clinical, laboratory, and radiological variables were collected. ITN was assessed on pathological reports of surgical specimens and/or on laparotomy findings in cases of open-close surgery. Factors associated with ITN were identified by univariate and multivariate analysis to derive a NOMI-ITN score. This score was further compared with the Clichy score.
We identified 4 factors associated with ITN in the context of NOMI: absence of bowel enhancement, bowel thinning, plasma bicarbonate concentration ≤15 mmol/L, and prothrombin rate <40%. These factors were included in a new NOMI-ITN score, with 1 point attributed for each variable. ITN was observed in 6%, 38%, 65%, 88%, and 100% of patients with NOMI-ITN score ranging from 0 to 4, respectively. The NOMI-ITN score outperformed the Clichy score for the prediction of ITN (area under the receiver operating characteristics curve 0.882 [95% confidence interval 0.826-0.938] vs 0.674 [95% confidence interval 0.582-0.766], respectively, P < 0.001).
We propose a new 4-point score aimed at stratifying risk of ITN in patients with NOMI. The Clichy score should be applied to patients with occlusive acute mesenteric ischemia only.
本研究旨在确定并发非闭塞性肠系膜缺血（NOMI）的危重症患者发生不可逆性透壁性坏死（ITN）的相关因素，并比较其在 ITN 风险分层方面的预测价值与先前描述的克利希评分。
纳入标准为 2009 年至 2019 年期间因 NOMI 接受剖腹探查术且术前行增强 CT 检查并至少有 1 期门静脉期的连续患者。收集临床、实验室和影像学变量。通过手术标本的病理报告和/或剖腹手术中开腹-关腹手术的发现来评估 ITN。采用单因素和多因素分析确定与 ITN 相关的因素，以得出 NOMI-ITN 评分。进一步比较该评分与克利希评分。
在 NOMI 背景下，我们确定了 4 个与 ITN 相关的因素：肠壁无增强、肠壁变薄、血浆碳酸氢盐浓度≤15mmol/L 和凝血酶原率<40%。这些因素被纳入新的 NOMI-ITN 评分，每个变量记 1 分。NOMI-ITN 评分为 0 至 4 分的患者中，分别有 6%、38%、65%、88%和 100%出现 ITN。NOMI-ITN 评分在预测 ITN 方面优于克利希评分（受试者工作特征曲线下面积分别为 0.882[95%置信区间 0.826-0.938]和 0.674[95%置信区间 0.582-0.766]，P<0.001）。
我们提出了一种新的 4 分评分系统，旨在对 NOMI 患者的 ITN 风险进行分层。克利希评分仅适用于伴有闭塞性急性肠系膜缺血的患者。
