Non-occlusive mesenteric ischemia in critically ill patients

Abstract

Background: Non-occlusive mesenteric ischemia (NOMI) is a life-threatening acute condition that has an overall in-hospital mortality rate of up to 75%. Critically ill patients are often admitted to intensive care units (ICUs) due to shock, and these patients are frequently at risk of developing NOMI. The objective of this study was to determine the clinical features of critically ill patients with NOMI and evaluate the risk factors for in-hospital mortality among these patients.

Methods: We reviewed the electronic medical records of 7,346 patients who underwent abdominal contrast-enhanced computed tomography during their ICU stay at Samsung Medical Center (Seoul, Korea) between January 1, 2010 and December 31, 2019. After reviewing each patient's computed tomography (CT) scans, 60 patients were diagnosed with NOMI and included in this analysis. The patients were divided into survivor (n = 23) and non-survivor (n = 37) groups according to the in-hospital mortality.

Results: The overall sequential organ failure assessment (SOFA) score for the included patients upon admission to the ICU was 8.6 ± 3.1, and medical ICU admissions were most common (66.7%) among the patients. The SOFA score upon admission to the ICU was higher for the non-survivors than for the survivors (9.4 vs. 7.4; p = 0.017). Non-survivors were more often observed in the medical ICU admissions (39.1% vs. 83.8%) than in the surgical ICU admissions (47.8% vs. 10.8%) or the cardiac ICU admissions (13.0% vs. 5.4%). Laboratory test results, abdominal CT findings, and the use of vasopressors and inotropes did not differ between the two groups. In a multivariable analysis, SOFA scores >8 upon admission to the ICU (odds ratio [OR] 4.51; 95% 1.12-18.13; p = 0.034), patients admitted to the ICU with medical problems (OR 7.99; 95% 1.73-36.94; p = 0.008), and abdominal pain (OR 4.26; 95% 1.05-17.35; p = 0.043) were significant prognostic predictors for in-hospital mortality.

Conclusions: The SOFA score >8 upon admission to the ICU, admission to the ICU for medical problems, and abdominal pain at diagnosis are associated with increased mortality among patients with NOMI.

Fig 1. The patient enrollment scheme for this study.

CT, computed tomography; ICU, intensive care unit.

Fig 2. Contrast-enhanced CT images and intraoperative bowel images of non-occlusive mesenteric ischemia.

(A) Contract-enhanced abdomen CT images of survivor, transverse image (B) Contract-enhanced abdomen CT images of non-survivor, transverse image (C) Contract-enhanced abdomen CT images of non-survivor, sagittal image (D) intraoperative bowel images; multiple segmental bowel necrosis was observed, but also normal bowel and mesentery found between necrotic bowel segments. Yellow arrows indicate the dilated and thinned bowel and blue arrows indicate normal bowel.

Fig 3. The peak vasoactive-inotropic scores according to the in-hospital mortality.

The bold line in the middle indicates the median, and the top and bottom of the square indicate the interquartile ranges of the vasoactive-inotropic scores. VIS, vasoactive-inotropic score.