Predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases

Objective To explore the predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases and its significance for the timing of exploratory laparotomy. Methods This retrospective study enrolled 63 patients diagnosed as acute mesenteric vascular occlusive diseases at Peking University People′s Hospital between July 1995 and June 2015. Univariate analysis and multivariate logistic regression analysis were used to identify predictive factors for intestinal necrosis. Results Of 63 patients, 39 were male and 24 were female, with a mean age of (58.8 ± 12.7) (31 to 82) years. The overall rate of intestinal necrosis was 46.0% (29/63) . Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (χ2= 5.908, P= 0.015) . In univariate analysis, the predictive factors of intestinal necrosis were systemic inflammatory reactive syndrome (SIRS) (χ2= 18.535, P= 0.000) , shock (χ2= 7.775, P= 0.007) , peritoneal irritation sign (χ2= 11.533, P= 0.001) , changes of intestinal wall and blood signals on ultrasound or CT scans (χ2= 14.344, P= 0.000) , international normalized ratio (INR) (prothrombin time) ≥1.2 (χ2= 4.498, P= 0.034) , D-dimer≥1 000 g/L (χ2= 6.680, P= 0.010) , low-density lipoprotein ≥270 U/L (χ2= 6.513, P= 0.011) , serum albumin < 35 g/L (χ2= 3.914, P= 0.048) , blood urea nitrogen ≥ 6.2 mmol/L (χ2= 11.377, P= 0.000) , pH values < 7.35 (χ2= 15.887, P= 0.000) , blood lactate≥2 mmol/L (χ2= 17.134, P= 0.000) , base excess <-1.0 mmol/L (χ2= 6.674, P= 0.010) . According to multivariate logistic regression analysis, SIRS (OR= 28.945, 95%CI: 2.294 to 365.199, P= 0.009) , pH values < 7.35 (OR= 13.174, 95%CI: 1.157 to 150.027, P= 0.038) , changes of intestinal wall and blood signals on ultrasound or CT scans (OR= 4.857, 95%CI: 1.110 to 21.253, P= 0.036) were independent predictive factors of intestinal necrosis in patients with acute mesenteric vascular occlusive diseases. Conclusions Intestinal necrosis in acute mesenteric vascular occlusive diseases prompts a poor prognosis. When patients with acute mesenteric vascular occlusive diseases are found to have acidosis, SIRS and changes of intestinal wall and blood signals on ultrasound or CT scans, surgeons should be alert to the occurrence of intestinal necrosis and should perform laparotomy promptly in order to take suitable management. Key words: Mesenteric vascular occlusion; Intestinal necrosis; Predictive factors