Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4020-4032
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4020
Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism
Ju-Shun Yang, Zhen-Yu Xu, Fei-Xiang Chen, Mei-Rong Wang, Ruo-Chen Cong, Xiao-Le Fan, Bo-Sheng He, Wei Xing
Ju-Shun Yang, Wei Xing, Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
Ju-Shun Yang, Fei-Xiang Chen, Mei-Rong Wang, Ruo-Chen Cong, Xiao-Le Fan, Bo-Sheng He, Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Zhen-Yu Xu, Department of Ultrasonography, The Second People's Hospital of Nantong, Nantong 226002, Jiangsu Province, China
Author contributions: Yang JS, He BS and Xing W were responsible for design of the study and reviewed the manuscript; Yang JS drafted the manuscript; Xu ZY, Chen FX and Wang MR performed data collection and analysis; Yang JS, Fan XL and Cong RC prepared the figures and tables; He BS and Xing W were responsible for revising manuscript. All authors have read and approved the final manuscript.
Supported by The "333" Talent Funding Project of Jiangsu Province, No. BRA2020198; Nantong City Social Development Project-Standardized Diagnosis and Treatment of Key Diseases No. HS2019002; and The Youth Project of Nantong City Health Committee, No. QA2019006 and QA2020002.
Institutional review board statement: The study was approved by the ethics committee of the Second Affiliated Hospital of Nantong University. Since this study is a retrospective study.
Informed consent statement: No informed consent was needed.
Conflict-of-interest statement: No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
Data sharing statement: All data generated or analyzed during this study are available from the corresponding author Wei Xing upon reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Xing, MD, Doctor, Department of Radiology, The Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Tianning District, Changzhou 213003, Jiangsu Province, China. suzhxingwei@suda.edu.cn
Received: November 2, 2021
Peer-review started: November 2, 2021
First decision: February 14, 2022
Revised: February 25, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 6, 2022
Processing time: 178 Days and 18.7 Hours
Abstract
BACKGROUND

Superior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. Multidetector computed tomography (MDCT) is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.

AIM

To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.

METHODS

Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected. Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.

RESULTS

Univariate Cox regression model showed that intestinal wall thinning, intestinal wall pneumatosis, blood lactate > 2.1 mmol/L and blood pH < 7.35 increased the risk of death in patients with SMAE. After adjusting for age, sex, embolic involvement length and embolic distribution region, multivariate Cox regression model I showed that blood lactate > 2.1 mmol/L (HR = 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR = 9.40, 95%CI: 1.05-83.46, P = 0.044) were significantly increases the risk of death in patients with SMAE.

CONCLUSION

For patients with SAME, increased blood lactate and intestinal wall thinning are the risk factors for death; hence, close monitoring may reduce the mortality rate. Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.

Keywords: Multidetector computed tomography; Superior mesenteric artery; Embolization; Blood lactate

Core Tip: Acute superior mesenteric artery embolism (SAME) has a rapid onset and progression and lacks specific clinical and biochemical diagnostic indicators, resulting in delayed diagnosis and poor prognosis. Currently, multidetector computed tomography (MDCT) is recommended as the first-line examination method for diagnosing mesenteric vascular diseases. However, when there is no clinical doubt, radiologists can easily miss SMAE with length ≤ 20 mm and in regions III and IV, affecting early treatment of patients. We found that a serum lactate level > 2.1 mmol/L and intestinal wall thinning on MDCT could independently predict the risk factors of death in patients with SMAE.