title: Acute mesenteric ischemia following cardiovascular surgery--A nested case-control study.
abstract: BACKGROUND
  Acute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia.
  
  
  METHODS
  In a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses.
  
  
  RESULTS
  Of 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6-49.3), and emergency operation (OR 2.6, CI95% 1.3-5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6-7.8), epinephrine (OR 2.0, CI95% 1.1-3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5-5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy.
  
  
  CONCLUSIONS
  Early identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates.
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: henning.mothes@med.uni-jena.de.
authors.forename: H
authors.initials: H
authors.lastname: Mothes
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: jonaskoeppen@posteo.de.
authors.forename: J
authors.initials: J
authors.lastname: Koeppen
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Ole.Bayer@med.uni-jena.de.
authors.forename: O
authors.initials: O
authors.lastname: Bayer
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Markus.Richter@med.uni-jena.de.
authors.forename: M
authors.initials: M
authors.lastname: Richter
authors.affiliation: Central Service Provider for Information Technology (IT) Services, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Bjoern.Kabisch@med.uni-jena.de.
authors.forename: B
authors.initials: B
authors.lastname: Kabisch
authors.affiliation: Center for Sepsis Control and Care, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: daniel.schwarzkopf@med.uni-jena.de.
authors.forename: D
authors.initials: D
authors.lastname: Schwarzkopf
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, 3300 Oak Lawn Ave, Ste 200, Dallas, TX 75219, Dallas, USA. Electronic address: tillhein@gmail.com.
authors.forename: H A T
authors.initials: HA
authors.lastname: Hein
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Juergen.Zanow@med.uni-jena.de.
authors.forename: J
authors.initials: J
authors.lastname: Zanow
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Doenst@med.uni-jena.de.
authors.forename: T
authors.initials: T
authors.lastname: Doenst
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: utz.settmacher@med.uni-jena.de.
authors.forename: U
authors.initials: U
authors.lastname: Settmacher
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D004630:Emergencies; D004837:Epinephrine / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D065666:Mesenteric Ischemia / Q000209:etiology* / Q000401:mortality; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014662:Vasoconstrictor Agents / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D009638:Norepinephrine; D004837:Epinephrine
keywords: Acute mesenteric ischaemia; Cardiovascular surgery; Case-control study