Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism

Table 1 MDCT scan parameters

Group	Scan protocol/parameters
Scan area	From diaphragm top to lower edge of symphysis pubis
Body position	Supine position
Tube voltage (kV)/tube current (mAs)	120/care dose 4D
Linear fusion coefficient	0.5
Pitch	1.0
Rotate speed	0.5 s
Collimation (mm)	2 × 192 × 0.6
Thickness of collection layer (mm)	1 mm
Interlayer spacing	0.6 mm
Convolution kernel	Br40
Enhancement protocol	Arterial phase (automatic tracking technology: when the aortic monitoring threshold reached 100 HU, the arterial phase scan was triggered); intravenous phase (scan started 75 s after the contrast agent was injected)
Contrast agent (concentration)	Iopromide (370 mgI/mL)
Dose and rate of contrast agent administration	1.5 mL/kg, 3.5 mL/s

Table 2 The demographic characteristics of death and survival groups

	Total number (n = 53)	Survival group (n = 44)	Death group (n = 9)	P value
Sex (%)				0.938
Male	33 (62.3)	28 (52.8)	5 (9.4)
Female	20 (37.7)	16 (30.2)	4 (7.5)
Smoking (%)				1.000
No	35 (66.0)	29 (54.7)	6 (11.3)
Yes	18 (34.0)	15 (28.3)	3 (5.7)
Alcohol (%)				0.667
No	35 (66.0)	28 (52.8)	7 (13.2)
Yes	18 (34.0)	16 (30.2)	2 (3.8)
Diabetes (%)				0.978
No	44 (83.0)	36 (67.9)	8 (15.1)
Yes	9 (17.0)	8 (15.1)	1 (1.9)
Hypertension (%)				1.000
No	27 (50.9)	22 (41.5)	5 (9.4)
Yes	26 (49.1)	22 (41.5)	4 (7.5)
Heart disease (%)				1.000
No	26 (49.1)	22 (41.5)	4 (7.5)
Yes	27 (50.9)	22 (41.5)	5 (9.4)
Surgery (%)				0.395
No	38 (71.7)	30 (56.6)	8 (15.1)
Yes	15 (28.3)	14 (26.4)	1 (1.9)
Vomitus (%)				0.938
No	20 (37.7)	16 (30.2)	4 (7.5)
Yes	33 (62.3)	28 (52.8)	5 (9.4)
Age (yr)	74 (63.50, 80.50)	72 (62.25, 80.00)	75 (73.00, 82.00)	0.231
Abdominal pain duration (d)	1.00 (1.00, 5.00)	2.00 (1.00, 5.00)	1.00 (0.75, 2.00)	0.298
Body temperature at admission (℃)	36.7 (36.5, 37.7)	36.6 (36.4, 37.3)	37.7 (36.6, 38.4)	0.055

Table 3 Biochemical indicators of death and survival groups

	Total number (n = 53)	Survival group (n = 44)	Death group (n = 9)	P value
D-dimer > 1000 μg/mL (%)				0.499
No	20 (37.7)	18 (34.0)	2 (3.8)
Yes	33 (62.3)	26 (49.1)	7 (13.2)
Blood lactate > 2.1 mmol/L (%)				0.004
No	44 (83.0)	40 (75.5)	4 (7.5)
Yes	9 (17.0)	4 (7.5)	5 (9.4)
Blood pH < 7.35 (%)				0.004
No	47 (88.7)	42 (79.2)	5 (9.4)
Yes	6 (11.3)	2 (3.8)	4 (7.5)
Blood amylase > 110 U/L (%)				0.027
No	32 (84.2)	29 (76.3)	3 (7.9)
Yes	6 (15.8)	3 (7.9)	3 (7.9)
Serum creatinine > 120 μmol/L (%)				0.097
No	36 (78.3)	32 (69.6)	4 (8.7)
Yes	10 (21.7)	6 (13.0)	4 (8.7)
White blood cell	10.6 (6.95, 15.45)	9.1 (6.73, 16.48)	10.7 (9.2, 14.6)	0.362
Red blood cell	4.19 (3.89, 4.64)	4.18 (3.97, 4.63)	4.48 (3.60, 4.94)	0.887
Neutrophil	8.5 (5.42, 13.66)	7.55 (5.36, 14.46)	9.42 (7.75, 12.90)	0.236
Lymphocyte	0.9 (0.6, 1.2)	0.90 (0.60, 1.20)	0.70 (0.55, 1.20)	0.392
Neutrophil/lymphocyte	9.3 (6.00, 16.22)	8.47 (5.48, 16.42)	13.46 (8.52, 17.33)	0.169
Total protein	64.4 (56.55, 70.85)	64.2 (56.73, 69.45)	67.0 (51.3, 76.05)	0.713
Albumin to total protein ratio	1.20 (1.0, 1.3)	1.20 (1.00, 1.38)	1.10 (1.00, 1.30)	0.516
Blood glucose	6.90 (5.65, 8.44)	6.8 (4.93, 8.44)	7.70 (6.90, 16.28)	0.107

Data are expressed as numbers (%) or medians (range).

Table 4 Comparison of multidetector computed tomography reading results of two radiologists

	Total number	A	B	P value
Embolus involvement length (%)
≤ 20 mm	14	6	13	0.014
20-50 mm	11	10	11	1
≥ 50 mm	28	25	28	0.236
Embolus region (%)
I	5	4	5	1
II	1	1	1	1
III	2	0	2	0.024
IV	8	3	7
I + II	2	2	2	1
III + IV	19	18	19	1
I + II + III	1	1	1	1
II + III + IV	7	6	7	1
I + II + III + IV	8	8	8	1
Extravascular signs (%)
Decreased intestinal wall enhancement	30	24	28	0.255
Intestinal wall thinning	22	9	14	0.131
Intestinal wall thickening	14	14	14	1
Pneumatosis intestinalis	5	3	3	1
Infarction of the organs	22	18	22	0.108
Mesenteric fat stranding	29	25	27	0.67

Table 5 Comparison of multidetector computed tomography signs in death and survival groups

	Survival group (n = 44)	Death group (n = 9)	P value
Embolus involvement length (%)			0.311
≤ 20 mm	12 (27.27)	1 (11.11)
20-50 mm	10 (22.73)	1 (11.11)
≥ 50 mm	22 (50.00)	7 (77.78)
Embolus region (%)			0.212
I	4 (9.09)	1 (11.11)
II	1 (2.27)	0 (0)
III	2 (4.55)	0 (0)
IV	8 (18.18)	0 (0)
I + II	1 (2.27)	1 (11.11)
III + IV	17 (38.64)	2 (22.22)
I + II + III	1 (2.27)	0 (0)
II + III + IV	6 (13.64)	1 (11.11)
I + II + III + IV	4 (9.09)	4 (44.44)
Decreased intestinal wall enhancement (%)			0.004
No	23 (52.27)	0 (0)
Yes	21 (47.73)	9 (100)
Intestinal wall thinning (%)			0.002
No	30 (68.18)	1 (11.11)
Yes	14 (31.82)	8 (88.89)
Intestinal wall thickening (%)			0.178
No	34 (77.27)	5 (55.56)
Yes	10 (22.73)	4 (44.44)
Pneumatosis intestinalis (%)			0.007
No	42 (95.45)	6 (66.67)
Yes	2 (4.55)	3 (33.33)
Infarction of other organs (%)			0.348
No	27 (61.36)	4 (44.44)
Yes	17 (38.64)	5 (55.56)
Mesenteric fat stranding (%)			0.127
No	22 (50)	2 (22.22)
Yes	22 (50)	7 (77.78)

Table 6 Univariate cox regression

	HR	95%CI	P value
Intestinal wall thinking	2.27	(0.61-8.45)	0.223
Intestinal wall thinning	13.35	(1.54-99.01)	0.018
Pneumatosis intestinalis	5.73	(1.41-23.35)	0.015
Other organ infarction	1.79	(0.48-6.67)	0.386
mesenteric fat stranding	2.96	(0.62-14.27)	0.176
Blood lactate > 2.1 mmol/L	6.82	(1.82-25.60)	0.004
Blood pH < 7.35	7.36	(1.94-27.86)	0.003
Embolus distribution region (multi-classification variable)	1.42	(0.92-1.74)	0.156
Embolus involvement length
20-50 mm (vs ≤ 20 mm)	1.09	(0.07-17.50)	0.951
≥ 50 mm (vs ≤ 20 mm)	3.14	(0.39-25.54)	0.284

The end point is death, and the comparison group is the survival group. Since the death number of many embolism distribution groups was 0, the dummy variable cannot be set for analysis, so it was included as a multi-classification variable in the cox regression model.

Table 7 Multivariate cox regression

	Model1			Model2			Model3
	HR	95%CI	P value	HR	95%CI	P value	HR		95%CI	P value
Intestinal wall thinning	9.40	(1.05-83.46)	0.044	9.66	(1.15-81.03)	0.037	11.01	(1.32-92.22)		0.027
Pneumatosis intestinalis	4.58	(0.86-24.36)	0.074	6.09	(1.25-29.69)	0.025	6.01	(1.25-28.97)		0.025
Blood lactate > 2.1 mmol/L	5.26	(1.04-26.69)	0.045	5.21	(1.12-24.22)	0.035	6.34	(1.56-25.73)		0.010
Blood pH < 7.35	4.84	(0.94-25.09)	0.060	5.59	(1.26-24.88)	0.024	6.26	(1.47-26.59)		0.013

¹Adjusted for age, gender, embolus involvement length, and embolus distribution region;

²Adjusted for age, gender, and embolus distribution region;

³Age, embolus involvement length, and embolus distribution.