Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia

BACKGROUND: The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI. METHODS: Patients with bowel ischemia were identified by se...

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Autores principales: Toda, Yoko, Komatsu, Shunichiro, Fukami, Yasuyuki, Saito, Takuya, Matsumura, Tatsuki, Osawa, Takaaki, Kurahashi, Shintaro, Uchino, Tairin, Kato, Shoko, Yasui, Kohei, Hanazawa, Takaaki, Kaneko, Kenitiro, Sano, Tsuyoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166604/
https://www.ncbi.nlm.nih.gov/pubmed/35659015
http://dx.doi.org/10.1186/s13017-022-00436-w
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author Toda, Yoko
Komatsu, Shunichiro
Fukami, Yasuyuki
Saito, Takuya
Matsumura, Tatsuki
Osawa, Takaaki
Kurahashi, Shintaro
Uchino, Tairin
Kato, Shoko
Yasui, Kohei
Hanazawa, Takaaki
Kaneko, Kenitiro
Sano, Tsuyoshi
author_facet Toda, Yoko
Komatsu, Shunichiro
Fukami, Yasuyuki
Saito, Takuya
Matsumura, Tatsuki
Osawa, Takaaki
Kurahashi, Shintaro
Uchino, Tairin
Kato, Shoko
Yasui, Kohei
Hanazawa, Takaaki
Kaneko, Kenitiro
Sano, Tsuyoshi
author_sort Toda, Yoko
collection PubMed
description BACKGROUND: The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI. METHODS: Patients with bowel ischemia were identified by searching for “ICD-10 code K550” in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled. RESULTS: Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096–0.58). CONCLUSIONS: The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-022-00436-w.
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spelling pubmed-91666042022-06-05 Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia Toda, Yoko Komatsu, Shunichiro Fukami, Yasuyuki Saito, Takuya Matsumura, Tatsuki Osawa, Takaaki Kurahashi, Shintaro Uchino, Tairin Kato, Shoko Yasui, Kohei Hanazawa, Takaaki Kaneko, Kenitiro Sano, Tsuyoshi World J Emerg Surg Research BACKGROUND: The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI. METHODS: Patients with bowel ischemia were identified by searching for “ICD-10 code K550” in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled. RESULTS: Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096–0.58). CONCLUSIONS: The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-022-00436-w. BioMed Central 2022-06-03 /pmc/articles/PMC9166604/ /pubmed/35659015 http://dx.doi.org/10.1186/s13017-022-00436-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Toda, Yoko
Komatsu, Shunichiro
Fukami, Yasuyuki
Saito, Takuya
Matsumura, Tatsuki
Osawa, Takaaki
Kurahashi, Shintaro
Uchino, Tairin
Kato, Shoko
Yasui, Kohei
Hanazawa, Takaaki
Kaneko, Kenitiro
Sano, Tsuyoshi
Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
title Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
title_full Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
title_fullStr Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
title_full_unstemmed Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
title_short Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
title_sort prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166604/
https://www.ncbi.nlm.nih.gov/pubmed/35659015
http://dx.doi.org/10.1186/s13017-022-00436-w
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