Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-03-03

AUTHORS

Marc Leone, Carole Bechis, Karine Baumstarck, Alexandre Ouattara, Olivier Collange, Pascal Augustin, Djillali Annane, Charlotte Arbelot, Karim Asehnoune, Olivier Baldési, Simon Bourcier, Laurence Delapierre, Didier Demory, Baptiste Hengy, Carole Ichai, Eric Kipnis, Etienne Brasdefer, Sigismond Lasocki, Matthieu Legrand, Olivier Mimoz, Thomas Rimmelé, Jugurtha Aliane, Pierre-Marie Bertrand, Nicolas Bruder, Fanny Klasen, Emilie Friou, Bruno Lévy, Oriane Martinez, Eric Peytel, Alexandra Piton, Elisa Richter, Kamel Toufik, Marie-Charlotte Vogler, Florent Wallet, Mourad Boufi, Bernard Allaouchiche, Jean-Michel Constantin, Claude Martin, Samir Jaber, Jean-Yves Lefrant

ABSTRACT

BackgroundIn the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.MethodsA retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.ResultsThe death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.ConclusionAcute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI. More... »

PAGES

667-676

Journal

TITLE

Intensive Care Medicine

ISSUE

4

VOLUME

41

Author Affiliations

  • Service d’anesthésie et de réanimation, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France
  • Unité d’Aide Méthodologique à la Recherche Clinique et Epidémiologique, Aix Marseille Université, Marseille, France
  • CHU de Bordeaux, Service d’Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-Lévêque, Hôpital Haut Lévêque, Avenue Magellan, 33600, Pessac, France
  • Pôle Anesthésie, Réanimation Chirurgicale, SAMU, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  • Département d’Anesthésie Réanimation Chirurgicale, CHU Bichat Claude Bernard, 46 Rue Henri Huchard, Paris, France
  • University of Versailles, Montigny le Bretonneux, France
  • Réanimation Chirurgicale Polyvalente, Département d’Anesthésie et de Réanimation, Hôpital Pitié Salpétrière APHP, Paris, France
  • Department of Anesthesiology and Critical Care, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes Cedex 1, France
  • Service de réanimation, Centre Hospitalier d’Aix-en-Provence, Aix-en-Provence, France
  • Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg, Saint-Jacques, Paris, France
  • Service de Réanimation Polyvalente, CH Henri Duffaut, 305, rue Raoul Follereau, Avignon Cedex09, France
  • Service Réanimation Polyvalente-USC, Hôpital Sainte Musse, Avenue Sainte Claire Deville, Toulon, France
  • Département d’anesthésie-réanimation, Hôpital Edouard Herriot, Place d’Arsonval, Lyon, France
  • Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France
  • Surgical Critical Care Unit, Department of Anesthesiology and Critical Care, Lille University Teaching Hospital-CHU Lille, Lille, France
  • Pôle d’anesthésie-réanimation, CHU d’Angers, 4, rue Larrey, Angers, France
  • Department of Anesthesiology and Critical Care and SMUR and Burn Unit, Assistance Publique-Hôpitaux de Paris, GH St Louis Lariboisière, University of Paris 7 Denis Diderot, Paris, France
  • Service d’Anesthésie Réanimation, CHU de Poitiers, INSERM U1070, Université de Poitiers, Poitiers, France
  • Service de Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
  • Service de Réanimation, Centre Hospitalier de Cannes, Cannes, France
  • Département d’Anesthésie et de Réanimation, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
  • Medical Intensive Care Unit, CHU Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
  • Department of Medical Intensive Care and Hyperbaric Medicine, University Hospital of Angers, 4 rue Larrey, Angers, France
  • Service de Réanimation Médicale Brabois, Hôpital Brabois, CHU Nancy, Vandoeuvre-Les-Nancy, France
  • Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier University 1, Montpellier, France
  • Service de Reanimation, Hôpital d’Instruction des Armées Laveran, Marseille, France
  • Anesthesiology and Critical Care Department, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France
  • Département d’Anesthésie et de Réanimation, Hôpital la Conception, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
  • Medical-surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d’Orléans, Orléans, France
  • Service d’anesthésie reanimation, hospital Nord, CHU de Saint Etienne, Saint-priest-en-Jarez, France
  • Department of Anesthesia and Critical Care Medicine, Lyon-Sud Hospital, Hospices Civils de Lyon and University Lyon 1, Lyon, France
  • Service de chirurgie vasculaire, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
  • Réanimation Adultes et Unité de Soins Continus, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, Clermont-Ferrand, France
  • Intensive Care Unit, Anaesthesia and Critical Care Dept B, Saint-Eloi Teaching Hospital, INSERM U1046, Montpellier 1 University, Montpellier, France
  • Services des Réanimations, Division Anesthésie Réanimation Douleur Urgence, CHU de Nîmes, place du Pr-Robert-Debré, Nîmes, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-015-3690-8

    DOI

    http://dx.doi.org/10.1007/s00134-015-3690-8

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1042117389

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25731634


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        "datePublished": "2015-03-03", 
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        "description": "BackgroundIn the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.MethodsA retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.ResultsThe death rate of the 780 included patients was 58\u00a0%. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7\u00a0mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p\u00a0<\u00a00.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.ConclusionAcute mesenteric ischemia in ICU patients was associated with a 58\u00a0% ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7\u00a0mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.", 
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    26 schema:description BackgroundIn the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.MethodsA retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.ResultsThe death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.ConclusionAcute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.
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