The effect of Co-morbidity on early clinical decision making in acute mesenteric ischemia

INTRODUCTION Acute Mesenteric Ischemia (AMI) is a surgical emergency with a high mortality and morbidity rate. Prompt diagnosis and early surgical management is the cornerstone of management. In certain patients, however, treatment is futile and early palliative care, lessens patient and family distress. The aim of this study was to investigate factors, focusing on patient co-morbidity, that may predict futility of treatment and hence, guide clinicians in their decision making. PATIENTS AND METHODS Consecutive adult patients with AMI diagnosed on imaging were reviewed for demographics, co-morbidity, imaging and biochemical results. RESULTS Seventy patients were identified with average age of 67 (range 33 - 94). Overall hospital mortality was 72%. Patients were divided into three distinct groups, patients who recovered (27%), patients deceased despite surgical treatment (18%), and patients palliated on presentation (54%). Age was comparable between groups (61 vs. 69 vs. 69; p = 0.2). Length of stay was highest in the recovered group (41.6 vs. 12.3 vs. 2.8 days). Biochemically, only lactate level differed (3.1 vs. 2.3 vs. 5.3 mmol/L, p = 0.03). Both deceased and palliative group scored similarly but significantly higher than the recovered group in both the Charlson Comorbidity Index (4.2 & 5.6 vs. 3.4, p = 0.02) and Age adjusted Charlson Comorbidity Index (ACCI) (6.7 & 8.2 vs. 5; p < 0.01). Other co-morbidities of Atrial Fibrillation and hypertension were comparable. CONCLUSIONS Raised ACCI confers poor outcome in AMI despite surgical management. ACCI may be used to aid early decision making in AMI, predicting futility of treatment and altering management goals to palliative comfort care.