Cardiovascular Surgery and Interventions 2023, Vol 10, Num 3 Page(s): 154-160
Acute mesenteric ischemia in the surgical intensive care unit: Analysis of clinical characteristics and risk factors for mortality

İlker Kızıloğlu1, Ahmet Daylan2, Aslı Şener3, Hakan Aygün4, Şahin Bozok2

1Department of General Surgery, Izmir Bakırçay University, Çiğli Training and Research Hospital, Izmir, Türkiye
2Department of Cardiovascular Surgery, Izmir Bakırçay University, Çiğli Training and Research Hospital, Izmir, Türkiye
3Department of Emergency Medicine, Izmir Bakırçay University, Çiğli Training and Research Hospital, Izmir, Türkiye
4Department of Anesthesiology and Reanimation, Izmir Bakırçay University, Çiğli Training and Research Hospital, Izmir, Türkiye

Keywords: Acute mesenteric ischemia, arterial occlusive mesenteric ischemia, mesenteric venous thrombosis, nonocclusive mesenteric ischemia, prognostic factors
Objectives: This study aimed to present the clinical characteristics of patients followed due to acute mesenteric ischemia (AMI) in the surgical intensive care unit and evaluate mortality-related prognostic factors.

Patients and methods: This retrospective study reviewed clinical records of 28 patients (19 males, 9 females; mean age: 67.5±17 years; range, 29 to 86 years) who were followed due to AMI in the intensive care unit between May 2016 and April 2023. We analyzed the clinical characteristics, risk factors, and prognostic factors of the patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated in each patient to assess its prognostic value in AMI patients.

Results: Of the 28 patients, 19 had acute arterial occlusive mesenteric ischemia (AOMI), four patients had acute mesenteric venous thrombosis (MVT), and five patients had nonocclusive mesenteric ischemia (NOMI). Overall mortality was 60.7% (n=17). The mortality rate was 57.8% (n=11) in the AOMI group, 50.0% (n=2) in the MVT group, and 80.0% (n=4) in the NOMI group. Compared to survivors, the APACHE II score, shock incidence, arterial lactate concentration, specifically more prominent 24 h after diagnosis (p<0.001), acute renal failure, serum creatinine level, vasoactive agent consumption, and maximum vasopressor dose were significantly higher among nonsurvivors (p<0.05).

Conclusion: The clinical outcomes remain poor in AMI, and even in-hospital mortality is rather high. The death following AMI was mostly related to multiorgan failure, renal failure, elevated lactate level, and colon involvement. It appears that monitoring arterial lactate is helpful in identifying patients with poor prognosis. Early diagnosis, timely treatment, correction of shock, and renal protection are important to improve clinical prognosis.

DOI : 10.5606/e-cvsi.2023.1562