title: Predictive Factors of Intestinal Necrosis in Acute Mesenteric Ischemia: Prospective Study from an Intestinal Stroke Center.
abstract: To identify predictive factors for irreversible transmural intestinal necrosis (ITIN) in acute mesenteric ischemia (AMI) and establish a risk score for ITIN.
  
  
  
  This single-center prospective cohort study was performed between 2009 and 2015 in patients with AMI. The primary outcome was the occurrence of ITIN, confirmed by specimen analysis in patients who underwent surgery. Patients who recovered from AMI with no need for intestinal resection were considered not to have ITIN. Clinical, biological and radiological data were compared in a Cox regression model.
  
  
  
  A total of 67 patients were included. The origin of AMI was arterial, venous, or non-occlusive in 61%, 37%, 2% of cases, respectively. Intestinal resection and ITIN concerned 42% and 34% of patients, respectively. Factors associated with ITIN in multivariate analysis were: organ failure (hazard ratio (HR): 3.1 (95% confidence interval (CI): 1.1-8.5); P=0.03), serum lactate levels >2 mmol/l (HR: 4.1 (95% CI: 1.4-11.5); P=0.01), and bowel loop dilation on computerized tomography scan (HR: 2.6 (95% CI: 1.2-5.7); P=0.02). ITIN rate increased from 3% to 38%, 89%, and 100% in patients with 0, 1, 2, and 3 factors, respectively. Area under the receiver operating characteristics curve for the diagnosis of ITIN was 0.936 (95% CI: 0.866-0.997) depending on the number of predictive factors.
  
  
  
  We identified three predictive factors for irreversible intestinal ischemic injury requiring resection in the setting of AMI. Close monitoring of these factors could help avoid unnecessary laparotomy, prevent resection, as well as complications due to unresected necrosis, and possibly lower the overall mortality.
authors.affiliation: Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.|Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Nuzzo
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Colorectal Surgery, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Leon
authors.initials: L
authors.lastname: Maggiori
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Radiology, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.affiliation: Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Becq
authors.affiliation: Department of Hepatology, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Plessier
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Epidemiology, Biostatistics and Clinical Research, APHP, Beaujon Hospital, Clichy, APHP, France.|INSERM CIC-EC 1425 Bichat Hospital, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gault
authors.affiliation: Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.|Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Vascular Surgery, Bichat Hospital, Paris, APHP, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Radiology, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Vilgrain
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Intensive Care Unit and Anesthesiology, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.|Department of Colorectal Surgery, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.affiliation: Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.|Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: Department of Pathology, Beaujon Hospital, Clichy, APHP, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Cazals-Hatem
authors.affiliation: Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.|Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Corcos
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007238:Infarction / Q000097:blood / Q000209:etiology* / Q000601:surgery; D007410:Intestinal Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019344:Lactic Acid / Q000097:blood; D008297:Male; D065666:Mesenteric Ischemia / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D015999:Multivariate Analysis; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019344:Lactic Acid