Prognostic factors of acute mesenteric ischemia in ICU patients

BACKGROUND: The primary endpoint was to investigate the prognostic factors of acute mesenteric ischemia (AMI) in ICU patients. METHODS: Retrospective observational, non-interventional, monocentric study of a cohort of 214 ICU patients with a confirmed diagnosis of arterial AMI. RESULTS: We collected demographics, mortality, hospital stay, prior medical history, comorbidities, reasons for ICU admission, laboratory investigations, diagnostic procedures, therapy, severity scores. The 30-day mortality rate was 71% for the 214 patients with arterial AMI. The incidence of nonocclusive mesenteric ischemia was particularly high. AMI was a secondary diagnosis in 58% of patients. Half of the population was represented by surgical patients who mostly required an urgent procedure. The mortality rate was not different in the subgroup with aortic surgery. Three factors were associated with an increase or decrease in mortality: the maximal dose of vasopressors (VP) administered to the patient (OR = 1.20; 95%CI = 1.08–1.33; p < 0.001), arterial change in lactate values within the first 24 h of admission (OR = 1.24; 95%CI = 1.05–1.48; p = 0.012) and anticoagulation (OR = 0.19; 95%CI = 0.043–0.84; p = 0.029). CONCLUSIONS: Fatalities after AMI were related to a high incidence of multi-organ failure. The monitoring of arterial lactate appeared helpful to identify the patients with a poor prognosis.