Shuji Suzuki1, Hiroshi Kondo2, Akira Furukawa3, Kentaro Kawai4, Takafumi Yukaya5, Takashi Shimazui6, Masaji Tani7, Masakazu Yamamoto8. 1. Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Ibaraki, 300-0395, Japan. ssuzuki@tokyo-med.ac.jp. 2. Department of Radiology, Teikyo University Graduate School of Medicine, Tokyo, Japan. 3. Department of Radiology, Tokyo Metropolitan University, Tokyo, Japan. 4. Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan. 5. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 6. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 7. Department of Surgery, Shiga University of Medical Science, Shiga, Japan. 8. Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Non-occlusive mesenteric ischemia (NOMI) has a high mortality rate, but the analyses of preoperative prognostic factors for improving survival in patients suspected of having NOMI are scarce. We aimed to analyze the prognostic factors of preoperative examinations for NOMI. METHODS: The clinical data of 224 patients with NOMI were retrospectively collected for a multicenter survey. Clinicophysiological factors were compared between the survivors and non-survivors (N = 107/117) and between the operative and non-operative cases (N = 180/44) by univariate analysis using chi-square test and multivariate analysis using Cox proportional hazard models. In the operative cases, the prognostic operative factors were also analyzed. RESULTS: The overall mortality rate for NOMI was 52.2%. There were 129 male and 95 female patients. The mean age was 71.23 (14-94) years. Univariate analysis showed that cardiovascular complication, shock, abdominal pain, average blood pressure, systemic inflammatory response syndrome, aspartic aminotransferase, alanine transaminase, creatine phosphokinase, lactate dehydrogenase, base excess, prothrombin time-international normalized ratio, D-dimer, and fibrinogen degradation products were independent prognostic factors. Multivariate analysis showed that average blood pressure and base excess were independent prognostic factors. Among patients undergoing surgery, those with bowel resection had better prognosis than those without bowel resection, but those with long bowel resection had worse prognosis than those with short resection. Additional postoperative treatment was not effective compared with operation alone (P = 0.011). CONCLUSIONS: Prognostic factors of preoperative examinations for NOMI were average blood pressure and base excess. Patients with long bowel resection should be carefully monitored owing to their poor prognosis.
BACKGROUND:Non-occlusive mesenteric ischemia (NOMI) has a high mortality rate, but the analyses of preoperative prognostic factors for improving survival in patients suspected of having NOMI are scarce. We aimed to analyze the prognostic factors of preoperative examinations for NOMI. METHODS: The clinical data of 224 patients with NOMI were retrospectively collected for a multicenter survey. Clinicophysiological factors were compared between the survivors and non-survivors (N = 107/117) and between the operative and non-operative cases (N = 180/44) by univariate analysis using chi-square test and multivariate analysis using Cox proportional hazard models. In the operative cases, the prognostic operative factors were also analyzed. RESULTS: The overall mortality rate for NOMI was 52.2%. There were 129 male and 95 female patients. The mean age was 71.23 (14-94) years. Univariate analysis showed that cardiovascular complication, shock, abdominal pain, average blood pressure, systemic inflammatory response syndrome, aspartic aminotransferase, alanine transaminase, creatine phosphokinase, lactate dehydrogenase, base excess, prothrombin time-international normalized ratio, D-dimer, and fibrinogen degradation products were independent prognostic factors. Multivariate analysis showed that average blood pressure and base excess were independent prognostic factors. Among patients undergoing surgery, those with bowel resection had better prognosis than those without bowel resection, but those with long bowel resection had worse prognosis than those with short resection. Additional postoperative treatment was not effective compared with operation alone (P = 0.011). CONCLUSIONS: Prognostic factors of preoperative examinations for NOMI were average blood pressure and base excess. Patients with long bowel resection should be carefully monitored owing to their poor prognosis.