Miyagawa Yusuke, Yamamoto Yuta, Kitazawa Masato, Tokumaru Shigeo, Nakamura Satoshi, Koyama Makoto, Ehara Takehito, Hondo Nao, Iijima Yasuhiro, Soejima Yuji
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
Surg Res Pract. 2022 Mar 28;2022:1737161. doi: 10.1155/2022/1737161. eCollection 2022.
Acute mesenteric ischemia is a life-threatening complication after cardiovascular surgery with a mortality rate of 52.9-81.3%. However, few studies have evaluated the predictors of clinical outcome after treatment for acute mesenteric ischemia following cardiovascular surgery. Therefore, this study aimed to elucidate prognostic factors in patients who underwent laparotomy for acute mesenteric ischemia after cardiovascular surgery.
We retrospectively analyzed 29 patients (20 men and 9 women; median age, 71.0 years) who underwent laparotomy for acute mesenteric ischemia after cardiovascular surgery between January 2010 and August 2020. These patients were classified into the survivor group (comprising patients who were discharged or referred to another hospital, = 16) and the nonsurvivor group (comprising those who experienced in-hospital mortality, = 13). We compared clinical parameters between the groups to identify the predictors of outcomes.
More patients in the nonsurvivor group underwent emergency cardiovascular surgery (62.5% vs. 100%, = 0.017) and received hemodialysis (12.5% vs. 61.5%, = 0.008) at the onset of acute mesenteric ischemia than those in the survivor group. The prelaparotomy serum creatinine level was higher in the nonsurvivor group than in the survivor group (1.27 vs. 2.33 mg/dL, = 0.004). Logistic regression analysis revealed an association between preoperative serum creatinine level and in-hospital mortality (odds ratio 5.047, = 0.046), and Cox regression analysis demonstrated a relationship between serum creatinine level and in-hospital mortality (hazard ratio 1.610, = 0.009). The area under the curve (receiver operating characteristic analysis) for the serum creatinine level was 0.813. Furthermore, the optimal cutoff value of the serum creatinine level was 1.59 mg/dL with a sensitivity and specificity of 0.846 and 0.687, respectively, in predicting in-hospital mortality.
The elevated serum creatinine level was associated with a poor clinical outcome after surgery for acute mesenteric ischemia following cardiovascular surgery.
急性肠系膜缺血是心血管手术后一种危及生命的并发症，死亡率为52.9%-81.3%。然而，很少有研究评估心血管手术后急性肠系膜缺血治疗后临床结局的预测因素。因此，本研究旨在阐明心血管手术后因急性肠系膜缺血接受剖腹手术患者的预后因素。
我们回顾性分析了2010年1月至2020年8月期间因急性肠系膜缺血在心血管手术后接受剖腹手术的29例患者（20例男性和9例女性；中位年龄71.0岁）。这些患者被分为存活组（包括出院或转至另一家医院的患者，n = 16）和非存活组（包括院内死亡的患者，n = 13）。我们比较了两组之间的临床参数，以确定结局的预测因素。
与存活组相比，非存活组中更多患者在急性肠系膜缺血发作时接受了急诊心血管手术（62.5%对100%，P = 0.017）并接受了血液透析（12.5%对61.5%，P = 0.008）。非存活组剖腹术前血清肌酐水平高于存活组（1.27对2.33mg/dL，P = 0.004）。逻辑回归分析显示术前血清肌酐水平与院内死亡率之间存在关联（比值比5.047，P = 0.046），Cox回归分析表明血清肌酐水平与院内死亡率之间存在关系（风险比1.610，P = 0.009）。血清肌酐水平的曲线下面积（受试者工作特征分析）为0.813。此外，血清肌酐水平的最佳截断值为1.59mg/dL，预测院内死亡率的敏感性和特异性分别为0.846和0.687。
血清肌酐水平升高与心血管手术后急性肠系膜缺血手术治疗后的不良临床结局相关。
