Predictive factors of intestinal necrosis in acute mesenteric ischemia

Objectives. Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is man- datory. Methods. Registered data of 55 consecutive patients admitted to our center between January 2010 and Decem- ber 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correla- tion to its clinical spectre. Results. Tobacco use was the most statistically signifi- cant (p<0.01) cardiovascular disease risk factor involved in ITIN. Among lab tests, Serum lactate levels ˃ 2mmol/L resulted in a statistically significant association with ITIN (p=0.0001). Organ failure (defined as Marshall score> 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as pre- dictive factors of ITIN in multivariate analysis using logis- tic regression (OR 49.66 and p-value 0.0021). Conclusion. Our univariate and multivariate analysis iden- tified multiple factors (Serum lactate levels ˃ 2mmol/L,Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN.