Surgery for mesenteric infarction: prognostic factors associated with early death within 72 hours.
OBJECTIVE
The aim of this study was to look for preoperative and postoperative prognostic factors for early mortality, likely to be of use to clinicians in decision making.


METHODS
Prospective multicenter study.


METHODS
This study was conducted in 4 university hospitals in Northeast France.


METHODS
One hundred thirty-one patients with mesenteric infarction confirmed by pathologic examination were included.


METHODS
All patients underwent surgery and were hospitalized in the intensive care unit.


RESULTS
Twenty-eight patients (21.3%) underwent exploratory laparotomy only; 103 patients underwent bowel resection with/or without associated revascularization. The overall mortality rate at discharge was 74.8%. In the first 3 days, 60% of deaths occurred. The prognostic factors for death within 72 hours, obtained by logistic regression, were preoperative heart failure, lactate level over 5 mmol/L, aspartate aminotransferase over 200 IU/L, and total cholesterol level below 80 mg/dL, or procalcitonin level over 40 ng/L. From these results, a mortality prognostic score was derived. Probability of mortality within 72 hours was estimated to be 5% for patients with none of these factors and 97% for those with all 4. For deaths occurring after 72 hours, the only mortality prognostic factor was the existence of necrosed areas at the ends of bowel resections.


CONCLUSIONS
When patients have fewer than 3 of the prognostic factors described in the score, aggressive medical and surgical strategies could be appropriate. If necrosis is recorded at the ends of the resection, renewed surgery should be undertaken as soon as signs of new disturbances appear.
Merle
Corinne
C
Department of Medical Information, Univesrity Hospital of Reims, Reims, France.
Lepouse
Claire
C
De Garine
Alexandre
A
Frayssinet
Nathalie
N
Leymarie
Florence
F
Leon
Alain
A
Jolly
Damien
D
D000368:Aged; D001219:Aspartate Aminotransferases / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D015740:Calcitonin Gene-Related Peptide; D002784:Cholesterol / Q000378:metabolism; D005260:Female; D005602:France; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007238:Infarction / Q000401:mortality* / Q000601:surgery; D007511:Ischemia / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008643:Mesentery / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
C000606589:CALCA protein, human; D011498:Protein Precursors; D019344:Lactic Acid; D002116:Calcitonin; D002784:Cholesterol; D001219:Aspartate Aminotransferases; D015740:Calcitonin Gene-Related Peptide