Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis

Abstract

Objective: To estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022.

Eligibility criteria: Studies reporting data on the incidence and outcomes of AMI in adult populations.

Data extraction and synthesis: Data extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms.

Results: From 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis.Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (p<0.05). The mid/long-term mortality of AMI was 68.2% (95% CI 60.7 to 74.9). Mortality due to mesenteric venous thrombosis was 24.6% (95% CI 17.0 to 32.9) and of non-occlusive mesenteric ischaemia 58.4% (95% CI 48.6 to 67.7). The short-term mortality of revascularised occlusive arterial AMI was 33.9% (95% CI 30.7 to 37.4).

Conclusions: In adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised.

Prospero registration number: CRD42021247148.

Keywords: Adult intensive & critical care; VASCULAR MEDICINE; Vascular surgery.

Figure 1

Flow diagram showing the selection of studies included in the review. AMI, acute mesenteric ischaemia; MVT, mesenteric vein thrombosis; OcclArtAMI, occlusive arterial AMI.

Figure 2

Incidence of acute mesenteric ischaemia in general population, cases per 100 000 person years.

Figure 3

Proportion of patients with acute mesenteric ischaemia (AMI) among hospitalised patients.

Figure 4

Short-term (hospital or 30 days) mortality of acute mesenteric ischaemia (all forms). Subgroup analyses of studies including all patients independent of treatment method (upper panel) and of studies including only operated patients (lower panel) are presented. In brackets, the period of patient inclusion is indicated. AMI, acute mesenteric ischaemia.

Figure 5

Long-term (6 months to 5 years) mortality of acute mesenteric ischaemia, all forms. Subgroup analyses of studies including patients independent of treatment method (upper panel) and of studies including only operated patients (lower panel) are presented. In brackets, the period of patient inclusion is indicated. AMI, acute mesenteric ischaemia.

Figure 6

Long-term (6 months to 5 years) mortality of occlusive arterial acute mesenteric ischaemia (OcclArtAMI). Subgroup analyses of studies including patients independent of treatment method (upper panel), of studies including only operated patients (middle panel), and of studies including only patients with revascularisation (lower panel) are presented. In brackets, the period of patient inclusion is indicated.

Figure 7

Long-term (2 months to 5 years) mortality of mesenteric vein thrombosis (MVT). In brackets, the period of patient inclusion is indicated.