title: Risk factors for nonocclusive mesenteric ischemia after elective cardiac surgery.
abstract: OBJECTIVE
  Nonocclusive mesenteric ischemia (NOMI) may occur after cardiopulmonary bypass. It is crucial to early identify patients who are at risk of developing this complication. The aim of this prospective study was to evaluate perioperative risk factors in a large cohort of patients undergoing elective cardiac surgery.
  
  
  METHODS
  From January 1, 2010, to March 31, 2011, all patients scheduled for elective cardiac surgery were screened for participation in this trial. If NOMI was suspected, arterial angiography was performed. NOMI and non-NOMI patients were compared with respect to all variables assessed in this study. Additionally, odds ratios were calculated. Linear discriminant analyses as well as logistic regression analyses were performed to develop a model that identifies patients at risk for developing NOMI.
  
  
  RESULTS
  Eight hundred sixty-five patients were included in the study, of whom 78 developed NOMI. Among preoperative parameters, renal insufficiency, diuretic therapy, and age >70 years showed the highest odds ratios for postoperative NOMI. The highest odds ratios for development of NOMI were observed with postoperative variables. In particular, the need for intra-aortic balloon pump support and serum lactate concentrations >5 mmol/L proved to be serious risk factors. Using a linear discriminant analysis with 7 variables, 92.3% of patients were correctly classified (sensitivity 76.9%, specificity 93.8%).
  
  
  CONCLUSIONS
  A high index of suspicion for NOMI in patients with the above-mentioned risk factors may decrease the diagnostic and therapeutic delay. To identify at-risk patients the developed risk equation is a useful tool with a high specificity.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Heinrich Volker
authors.initials: HV
authors.lastname: Groesdonk
authors.forename: Matthias
authors.initials: M
authors.lastname: Klingele
authors.forename: Sandra
authors.initials: S
authors.lastname: Schlempp
authors.forename: Hagen
authors.initials: H
authors.lastname: Bomberg
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schmied
authors.forename: Peter
authors.initials: P
authors.lastname: Minko
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*