Otto Carlos Constantin, Czigany Zoltan, Heise Daniel, Bruners Philipp, Kotelis Drosos, Lang Sven Arke, Ulmer Tom Florian, Neumann Ulf Peter, Klink Christian, Bednarsch Jan
Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany.
J Clin Med. 2022 Jun 23;11(13):3619. doi: 10.3390/jcm11133619.
Postoperative mortality in patients undergoing surgical and/or interventional treatment for acute mesenteric ischemia (AMI) has remained an unsolved problem in recent decades. Here, we investigated clinical predictors of postoperative mortality in a large European cohort of patients undergoing treatment for AMI. In total, 179 patients who underwent surgical and/or interventional treatment for AMI between 2009 and 2021 at our institution were included in this analysis. Associations between postoperative mortality and various clinical variables were assessed using univariate and multivariable binary logistic regression analysis. Most of the patients were diagnosed with arterial ischemia (AI; = 104), while venous ischemia (VI; = 21) and non-occlusive mesenteric ischemia (NOMI; = 54) were present in a subset of patients. Overall inhouse mortality was 55.9% (100/179). Multivariable analyses identified leukocytes (HR = 1.08; = .008), lactate (HR = 1.25; = 0.01), bilirubin (HR = 2.05; = 0.045), creatinine (HR = 1.48; = 0.039), etiology (AI, VI or NOMI; = 0.038) and portomesenteric vein gas (PMVG; HR = 23.02; = 0.012) as independent predictors of postoperative mortality. In a subanalysis excluding patients with fatal prognosis at the first surgical exploration ( = 24), leukocytes (HR = 1.09; = 0.004), lactate (HR = 1.27; = 0.003), etiology (AI, VI or NOMI; = 0.006), PMVG (HR = 17.02; = 0.018) and intraoperative FFP transfusion (HR = 4.4; = 0.025) were determined as independent predictors of postoperative mortality. Further, the risk of fatal outcome changed disproportionally with increased preoperative lactate values. The clinical outcome of patients with AMI was determined using a combination of pre- and intraoperative clinical and radiological characteristics. Serum lactate appears to be of major clinical importance as the risk of fatal outcome increases significantly with higher lactate values.
近几十年来，接受急性肠系膜缺血（AMI）手术和/或介入治疗患者的术后死亡率一直是个未解决的问题。在此，我们调查了欧洲一大群接受AMI治疗患者术后死亡率的临床预测因素。本分析纳入了2009年至2021年间在我们机构接受AMI手术和/或介入治疗的179例患者。使用单变量和多变量二元逻辑回归分析评估术后死亡率与各种临床变量之间的关联。大多数患者被诊断为动脉缺血（AI；n = 104），而一部分患者存在静脉缺血（VI；n = 21）和非闭塞性肠系膜缺血（NOMI；n = 54）。总体院内死亡率为55.9%（100/179）。多变量分析确定白细胞（HR = 1.08；P = 0.008）、乳酸（HR = 1.25；P = 0.01）、胆红素（HR = 2.05；P = 0.045）、肌酐（HR = 1.48；P = 0.039）、病因（AI、VI或NOMI；P = 0.038）和门静脉肠系膜静脉气体（PMVG；HR = 23.02；P = 0.012）为术后死亡率的独立预测因素。在一项排除首次手术探查时预后不良患者（n = 24）的亚分析中，白细胞（HR = 1.09；P = 0.004）、乳酸（HR = 1.27；P = 0.003）、病因（AI、VI或NOMI；P = 0.006）、PMVG（HR = 17.02；P = ）和术中新鲜冰冻血浆输注（FFP；HR = 4.4；P = 0.025）被确定为术后死亡率的独立预测因素。此外，随着术前乳酸值升高，致命结局风险的变化不成比例。AMI患者的临床结局通过术前和术中临床及放射学特征的综合评估来确定。血清乳酸似乎具有重要临床意义，因为随着乳酸值升高，致命结局风险显著增加。
