The challenging management of acute mesenteric ischemia - too frail or too late?
DOI:
https://doi.org/10.48750/acv.605Keywords:
Acute mesenteric ischemia, mortality, prognostic factorsAbstract
INTRODUCTION: acute mesenteric ischemia (AMI) presents a life-threatening emergency, requiring a high degree of suspicion for timely diagnosis. Despite advancements in the management of these patients, in-hospital mortality rates remain high. This study aims to assess the outcomes and prognostic factors in patients with AMI.METHODS: A retrospective single-center analysis of all patients undergoing emergent surgery for arterial occlusive AMI between January 2020 and February 2024 was conducted. The primary outcome was 30-day survival. Correlations between survival and laboratory biomarkers at admission were investigated.
RESULTS: Thirty patients underwent emergent surgery for occlusive AMI. The overall 30-day survival rate was 33%. Pre-operative arterial HCO3-to-lactate ratio ≤ 10 and neutrophil-to-lymphocyte ratio > 16 correlated with lower survival, showing 83% and 59% sensitivities, respectively, and 100% specificity for 30-day mortality.
CONCLUSION: Despite advancements in patient management strategies, AMI mortality rates remain high. The neutrophil-to-lymphocyte ratio has been proposed as a diagnostic and prognostic marker in AMI. While the HCO3-to-lactate ratio has not yet been described, it may serve as a more sensitive and specific predictor of mortality than lactate alone.
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