Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis

doi:10.3748/wjg.v26.i25.3625

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World Journal of Gastroenterology

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1007-9327

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Retrospective Cohort Study

World J Gastroenterol. Jul 7, 2020; 26(25): 3625-3637
Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3625

Table 1 Characteristics of acute mesenteric venous thrombosis patients treated by transcatheter thrombolysis

Variable	All patients	Without resection	With resection	P value
Variable	n = 58	n = 26	n = 32	P value
Age, yr, mean ± SD	45 ± 12.4	44.6 ± 10.4	47.6 ± 13.8	0.366
Male, n (%)	39 (67.2)	16 (61.5)	23 (71.9)	0.404
Location of thrombosis, n (%)				0.752
SMV	12 (20.7)	6 (23.1)	6 (18.8)
SMV + PV	46 (79.3)	20 (76.9)	26 (81.3)
Duration of anticoagulation alone before catheter-directed thrombolysis, h, median (IQR)	28.5 (22-54.8)	36 (22.8-72)	27 (18.8-48)	0.143
Thrombolytic approaches, n (%)				0.199
PT/TI-PV-SMV + SMA catheterization	42 (72.4)	21 (80.8)	21 (65.6)
SMA catheterization alone	16 (27.6)	5 (19.2)	11 (34.4)
Days of thrombolysis, d, mean ± SD	7.1 ± 2.9	6.7 ± 2.9	7.3 ± 2.8	0.421
APACHE II score, mean ± SD	10.6 ± 4.2	8.4 ± 3.5	12.5 ± 3.9	< 0.001
Associated comorbidities, n (%)
Liver cirrhosis/portal hypertension	11 (19.0)	7 (26.9)	4 (12.5)	0.163
Splenectomy	10 (17.2)	7 (26.9)	3 (9.4)	0.078
History of other abdominal surgery	9 (15.5)	5 (19.2)	4 (12.5)	0.481
History of thrombosis	9 (15.5)	2 (7.7)	7 (21.9)	0.138
Active smoking	13 (22.4)	6 (23.1)	7 (21.9)	0.913
Alcohol abuse	7 (12.1)	3 (11.5)	4 (12.5)	0.911
Hypertension	6 (10.3)	2 (7.7)	4 (12.5)	0.550
Diabetes mellitus	2 (3.4)	0 (0)	2 (6.3)	0.197
Duration of symptoms from onset to admission, d, median (IQR)	7 (4-13)	7 (4-15)	7 (4-12)	0.333
Clinical presentation, n (%)
Abdominal pain	53 (91.4)	23 (88.5)	30 (93.8)	0.475
Nausea and vomiting	28 (48.3)	12 (46.2)	16 (50.0)	0.771
Hematochezia	12 (20.7)	6 (23.1)	6 (18.8)	0.686
Local peritonitis	19 (32.8)	5 (19.2)	14 (43.8)	0.048

Quantitative variables are expressed as the mean ± SD or median and interquartile range (IQR). AMVT: Acute mesenteric venous thrombosis; SMV: Superior mesenteric vein; PV: Portal vein; SMA: Superior mesenteric artery; PT: Percutaneous transhepatic; TI: Trans-jugular intrahepatic; APACHE II: Acute Physiology and Chronic Health Evaluation II; IQR: Interquartile range.

Table 2 Laboratory and imaging examinations of acute mesenteric venous thrombosis patients treated by transcatheter thrombolysis

Variable	All patients	Without resection	With resection	P value
Variable	n = 58	n = 26	n = 32	P value
Laboratory examination
Total leukocyte count, × 10⁹/L, mean ± SD	14.3 ± 8.9	7.1 ± 2.2	20.3 ± 7.9	< 0.001
Hemoglobin, g/L, mean ± SD	114.3 ± 29.8	117.7 ± 27.3	111.5 ± 31.9	0.451
PLT, × 10⁹/L, mean ± SD	242.5 ± 160.7	287.8 ± 182.4	204.8 ± 131.4	0.056
Procalcitonin, µg/L, median (IQR)	0.25 (0.09-0.75)	0.14 (0.07-0.62)	0.42 (0.14-0.87)	0.096
CRP, mg/L, median (IQR)	59.8 (17.6-133.2)	19.0 (6.4-40.6)	120 (62.6-148.6)	< 0.001
Total bilirubin, µmol/L, mean ± SD	18.3 ± 15.5	13.6 ± 9.4	22.1 ± 18.4	0.035
ALT, U/L, median (IQR)	27 (36.3-51.9)	28 (17-43)	26 (14.5-38)	0.748
AST, U/L, median (IQR)	28 (20-38.8)	31 (21-42)	25 (19-36)	0.260
Serum albumin, g/L, mean ± SD	33.3 ± 5.2	35.8 ± 5.2	31.2 ± 4.2	0.001
D-dimer, µg/L, median (IQR)	5.6 (3.5-9.5)	3.9 (2.2-7.0)	6.5 (4.1-9.9)	0.081
Creatinine, µmol/L, mean ± SD	67.9 ± 35.6	57.3 ± 28.8	76.5 ± 38.7	0.040
Arterial lactate, mmol/L, mean ± SD	2.8 ± 0.9	2.1 ± 0.5	3.3 ± 0.8	< 0.001
Imaging Examination, n (%)
Free peritoneal fluid	35 (60.3)	13 (50.0)	22 (68.8)	0.147
Bowel loop dilation	25 (43.1)	9 (34.6)	16 (50.0)	0.239
Decreased bowel wall enhancement	11 (19.0)	2 (7.7)	9 (28.1)	0.048
Bowel wall thickening	32 (55.2)	12 (45.2)	20 (62.5)	0.213
Misty mesentery	23 (39.7)	8 (30.8)	15 (46.9)	0.212

Quantitative variables are expressed as the mean ± SD or median and interquartile range (IQR). AMVT: Acute mesenteric venous thrombosis; PLT: Platelet count; CRP: C-reactive protein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; IQR: Interquartile range.

Table 3 Outcome and complications of acute mesenteric venous thrombosis patients treated by transcatheter thrombolysis

Variable	All patients	Without resection	With resection	P value
Variable	n = 58	n = 26	n = 32	P value
Recanalization rate of SMV, n (%)
Complete recanalization	33 (56.9)	16 (61.5)	17 (53.1)	0.520
Partial recanalization	13 (22.4)	6 (23.1)	7 (21.9)	0.913
Invalid	5 (8.6)	0 (0)	5 (15.6)	0.035
Cavernous transformation	7 (12.1)	4 (15.4)	3 (9.4)	0.485
Length of bowel resection, cm, median (IQR)	100 (60-150)	ND	100 (60-150)	ND
Short bowel syndrome, n (%)	1 (1.7)	0 (0)	1 (3.1)	0.552
Surgical site infection, n (%)	3 (5.2)	0 (0)	3 (9.4)	0.161
Sepsis, n (%)	9 (15.5)	1 (3.8)	8 (25.0)	0.028
Hemorrhage, n (%)	2 (3.4)	1 (3.8)	1 (3.1)	0.700
Anastomotic or parastomal leakage, n (%)	2 (3.4)	0 (0)	2 (6.3)	0.497
AKI, n (%)	2 (3.4)	0 (0)	2 (6.3)	0.497
ARDS, n (%)	2 (3.4)	0 (0)	2 (6.3)	0.497
Liver dysfunction, n (%)	2 (3.4)	0 (0)	2 (6.3)	0.497
MODS, n (%)	6 (10.3)	0 (0)	6 (18.8)	0.022
Time of ICU stay, d, mean ± SD	9.1 ± 7.2	5.2 ± 3.9	12.1 ± 7.7	< 0.001
Time of hospital stay, d, mean ± SD	25.2 ± 14.9	16.6 ± 4.7	31.9 ± 16.7	< 0.001
30-d mortality, n (%)	5 (8.6)	0 (0)	5 (15.6)	0.035
1-yr mortality, n (%)	7 (12.1)	1 (3.8)	6 (18.8)	0.090

Quantitative variables are expressed as the mean ± SD or median and interquartile range (IQR). ND: No data; AMVT: Acute mesenteric venous thrombosis; SMV: Superior mesenteric vein; AKI: Acute kidney injury; ARDS: Acute respiratory distress syndrome; MODS: Multiple organ dysfunction syndrome; ICU: Intensive care unit; IQR: Interquartile range.

Table 4 Binary logistic regression analysis of risk factors associated with irreversible intestinal ischemia leading to resection in acute mesenteric venous thrombosis patients treated by transcatheter thrombolysis

Variable	P value	ORs	95%CI
APACHE II score	0.038	2.368	1.047-5.357
Leukocyte count	0.027	2.058	1.085-3.903
C-reactive protein	0.875	-	-
Arterial lactate	0.661	-	-
Serum albumin	0.547	-	-

AMVT: Acute mesenteric venous thrombosis; APACHE II: Acute Physiology and Chronic Health Evaluation II; ORs: Odds ratio; CI: Confidence interval.

Table 5 Diagnostic value of the risk factors for diagnosis of irreversible intestinal ischemia in acute mesenteric venous thrombosis patients treated by transcatheter thrombolysis

Variable	AUC	Cut-off value	Sensitivity	Specificity	PPV	NPV	Youden index
APACHE II score	0.728	8.5	0.933	0.440	0.682	0.833	0.373
Leukocyte count	0.947	12 × 10⁹	0.900	1	1	0.893	0.900

AMVT: Acute mesenteric venous thrombosis; APACHE II: Acute Physiology and Chronic Health Evaluation II; AUC: Area under curve; PPV: Positive predictive value; NPV: Negative predictive value.

Citation: Sun SL, Wang XY, Chu CN, Liu BC, Li QR, Ding WW. Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis. World J Gastroenterol 2020; 26(25): 3625-3637
URL: https://www.wjgnet.com/1007-9327/full/v26/i25/3625.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i25.3625