Effective new predictors of prognosis and comparison of multidisciplinary treatment options in acute mesenteric ischemia

Purpose: It was aimed to compare the prognostic risk factors and multidisciplinary treatments affecting mortality in acute mesenteric ischemia (AMI).
Methods: We retrospectively analyzed 111 patients treated for acute mesenteric ischemia between January 2012 and January 2023. Patients were divided into 2 groups as alive and dead for early survey (postoperative 28 days). The characteristics of the two groups were compared and the factors affecting early mortality were investigated. Factors affecting the presence of perioperative ischemia, the length of ischemia, the length of the resected bowel, and the length of the remaining small bowel from the ligament of treitz were investigated. The results of different treatment processes were analyzed.
Results: The mean age was 71.67 years with 64 (57.6%) males and 47 (42.3%) females. Early mortality rate was 47.7%. Envas was applied to 9 (8.1%) patients, EnvasSurg to 19 (17.1%) patients, Surg to 71 (64%) and SurgEnvas to 12 (10.8%) patients during the treatment process. Preoperative D-Dimer (p=0.013), lactate (p=0.006), creatine (p=0.001), LAR (p=0.031) were significantly different between the groups when compared according to the treatment process. The resected bowel length was significantly less in patients who underwent EnvasSurg compared to the other groups (p=0.002). CCI (p=0.041), D-Dimer (p=0.016), lactate (p<0.001), creatine (p<0.001), LAR (p<0.001) and ischemia length (p<0.001) were found to be significantly different between the groups.
Conclusions: The prognosis can be predicted with serum-based blood tests and indicators at the time of diagnosis, and organ loss and prognosis can be changed with the selected treatment process.

Akut mezenter iskemide prognozu öngeren yeni etkili faktörler ve multidisipliner tedavi seçeneklerinin karþýlaþtýrýlmasý

Amaç: Akut mezenter iskemide (AMI) mortaliteyi etkileyen prognostik risk faktörleri ve multidisipliner tedavilerin karþýlaþtýrýlmasý amaçlandý.
Yöntemler: Ocak 2012 ile Ocak 2023 tarihleri arasýnda akut mezenterik iskemi nedeniyle tedavi gören 111 hasta retrospektif olarak analiz edildi. Hastalar erken dönem (postoperatif 28 gün) için hayatta kalan ve ölen olarak 2 gruba ayrýldý. Ýki grubun özellikleri karþýlaþtýrýlarak erken mortaliteyi etkileyen faktörler araþtýrýldý. Perioperatif iskemi varlýðýný, iskeminin uzunluðunu, rezeke edilen baðýrsaðýn uzunluðunu ve treitz ligamanýndan kalan ince baðýrsaðýn uzunluðunu etkileyen faktörler araþtýrýldý. Farklý tedavi süreçlerinin sonuçlarý analiz edildi.
Bulgular: Ortalama yaþ 71,67 olup, 64'ü (%57,6) erkek, 47'si (%42,3) kadýndý. Erken ölüm oraný %47,7 oldu. Tedavi sürecinde 9 (%8,1) hastaya Envas, 19 (%17,1) hastaya EnvasSurg, 71 (%64) hastaya Surg ve 12 (%10,8) hastaya SurgEnvas uygulandý. Tedavi sürecine göre karþýlaþtýrýldýðýnda ameliyat öncesi D-Dimer (p=0,013), laktat (p=0,006), kreatin (p=0,001), LAR (p=0,031) deðerleri gruplar arasýnda anlamlý farklýlýk gösterdi. EnvasSurg uygulanan hastalarda rezeke edilen barsak uzunluðu diðer gruplara göre anlamlý olarak daha kýsaydý (p=0,002). CCI (p=0,041), D-Dimer (p=0,016), laktat (p<0,001), kreatin (p<0,001), LAR (p<0,001) ve gruplar arasýnda.iskemi uzunluðunun (p<0,001) anlamlý derecede farklý olduðu bulundu.
Sonuç: Taný anýnda serum bazlý kan testleri ve göstergeler ile prognoz tahmin edilebilir, seçilen tedavi süreci ile organ kaybý ve prognoz deðiþtirilebilir. (NCI-2023-11-4)