Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases.
BACKGROUND
In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.


METHODS
A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.


RESULTS
The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.


CONCLUSIONS
Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.
Service d'anesthésie et de réanimation, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France, marc.leone@ap-hm.fr.
Marc
M
Leone
Carole
C
Bechis
Karine
K
Baumstarck
Alexandre
A
Ouattara
Olivier
O
Collange
Pascal
P
Augustin
Djillali
D
Annane
Charlotte
C
Arbelot
Karim
K
Asehnoune
Olivier
O
Baldési
Simon
S
Bourcier
Laurence
L
Delapierre
Didier
D
Demory
Baptiste
B
Hengy
Carole
C
Ichai
Eric
E
Kipnis
Etienne
E
Brasdefer
Sigismond
S
Lasocki
Matthieu
M
Legrand
Olivier
O
Mimoz
Thomas
T
Rimmelé
Jugurtha
J
Aliane
Pierre-Marie
PM
Bertrand
Nicolas
N
Bruder
Fanny
F
Klasen
Emilie
E
Friou
Bruno
B
Lévy
Oriane
O
Martinez
Eric
E
Peytel
Alexandra
A
Piton
Elisa
E
Richter
Kamel
K
Toufik
Marie-Charlotte
MC
Vogler
Florent
F
Wallet
Mourad
M
Boufi
Bernard
B
Allaouchiche
Jean-Michel
JM
Constantin
Claude
C
Martin
Samir
S
Jaber
Jean-Yves
JY
Lefrant
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D065666:Mesenteric Ischemia / Q000401:mortality*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index