Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2020; 26(25): 3625-3637
Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3625
Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis
Shi-Long Sun, Xin-Yu Wang, Cheng-Nan Chu, Bao-Chen Liu, Qiu-Rong Li, Wei-Wei Ding
Shi-Long Sun, Xin-Yu Wang, Cheng-Nan Chu, Bao-Chen Liu, Qiu-Rong Li, Wei-Wei Ding, Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Sun SL designed the study, collected the data, and wrote the manuscript; Wang XY and Chu CN performed data collection; Liu BC and Li QR were involved in data analysis; Ding WW made substantial contributions to the conception, design, funding acquisition, and coordination of the study and gave final approval of the version to be published; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81770532; Jiangsu Province Medical Foundation for Youth Talents, China, No. QNRC2016901.
Institutional review board statement: This study was approved by the Ethics Committee of the Affiliated Jinling Hospital, Medical School of Nanjing University.
Informed consent statement: All involved subjects gave their informed consent (verbal) prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at dingwei_nju@hotmail.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Wei Ding, MD, PhD, Doctor, Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305, East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. dingwei_nju@hotmail.com
Received: March 11, 2020
Peer-review started: March 11, 2020
First decision: April 25, 2020
Revised: May 26, 2020
Accepted: June 9, 2020
Article in press: June 9, 2020
Published online: July 7, 2020
Processing time: 118 Days and 1.5 Hours
Abstract
BACKGROUND

Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear.

AIM

To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.

METHODS

The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.

RESULTS

Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively.

CONCLUSION

Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.

Keywords: Acute mesenteric venous thrombosis; Transcatheter thrombolysis; Irreversible intestinal ischemia; Surgical resection; Acute Physiology and Chronic Health Evaluation II score; Leukocytosis

Core tip: Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization in acute mesenteric venous thrombosis (AMVT) patients. However, irreversible intestinal ischemia still occurs in many cases. We compared AMVT patients with irreversible intestinal ischemia who underwent TT to patients with reversible intestinal ischemia. We demonstrated that the independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation II score and leukocytosis and the cutoff values were 8.5 and 12 × 109/L, respectively. Close monitoring of these factors may help with early identification of irreversible intestinal ischemia, which requires surgical resection, before initiation of TT in AMVT patients.