Clinical Features and Factors Affecting Postoperative Mortality for Obstructive Acute Mesenteric Ischemia in China: A Hospital- Based Survey

Figures & data

Table 1 Demographic Characteristics and Major Comorbidities for Different Types of Obstructive AMI

	ALL (n = 108)	MVT (n = 50)	AOMI (n = 58)	P
Age, year	57.1±16.8	49.1±16.1	64.1±14.3	<0.001
Male (%)	71 (65.7)	39 (78.0)	32 (55.2)	0.013
Weight (kg, IQR)	65 (55–75)	70 (56–78)	59 (50–70)	0.122
Cardiac disease (%)	26 (24.1)	4 (8.0)	22 (37.9)	<0.001
Hypertension (%)	28 (25.9)	8 (16.0)	20 (34.5)	0.029
Diabetes (%)	11 (10.2)	2 (4.0)	9 (15.5)	0.048
Liver disease (%)	14 (13.0)	11 (22.0)	3 (5.2)	0.009
Peripheral vascular disease (%)	9 (8.3)	7 (14.0)	2 (3.4)	0.103
Abdominal surgery (%)	39 (36.1)	22 (44.0)	17 (29.3)	0.113

Notes: Cardiac disease includes coronary heart disease, atrial fibrillation, and heart valve disease; Liver disease includes chronic hepatitis and cirrhosis.

Abbreviations: AOMI, arterial occlusive mesenteric ischemia; MVT, mesenteric venous thrombosis.

Table 2 Initial Clinical Symptoms and Physical Findings for Different Types of Obstructive AMI

	ALL (n = 108)	MVT (n = 50)	AOMI (n = 58)	P
Clinical symptoms
Abdominal pain (%)	102 (94.4)	47 (94.0)	55 (94.8)	0.851
Vomiting (%)	16 (14.8)	5 (10.0)	11 (19.0)	0.191
Abdominal distension (%)	35 (32.4)	20 (40.0)	15 (25.9)	0.118
Diarrhea (%)	8 (7.4)	3 (6.0)	5 (8.6)	0.881
Bloody stools (%)	15 (13.9)	7 (14.0)	8 (13.8)	0.975
Physical findings
Abdominal tenderness (%)	80 (74.1)	35 (70.0)	45 (77.6)	0.370
Rebounding pain (%)	69 (63.9)	31 (32.0)	38 (65.5)	0.704
Muscle guarding (%)	62 (57.4)	26 (52.0)	36 (62.1)	0.291

Abbreviations: AOMI, arterial occlusive mesenteric ischemia; MVT, mesenteric venous thrombosis.

Table 3 Laboratory Results for Different Types of Obstructive Acute Mesenteric Ischemia

	ALL (n = 108)	MVT (n = 50)	AOMI (n = 58)	P
Blood tests
WBC, mm^3	17,100±9100	17,000±9386	17,100±8912	0.932
Lymphocyte, %	7.8±5.6	8.2±4.7	7.3±6.3	0.412
NLR (median. IQR)	14.0 (7.7–21.4)	12.5 (6.8–18.2)	18.1 (9.1–24.6)	0.123
Platelet (*10^9/L)	178±87	174±105	182±68	0.643
Biochemical tests
ALB (g/L)	35.1±6.4	34.0±7.3	36.1±5.4	0.086
AST (U/L; median, IQR)	24.5 (18.0–43.8)	24.0 (17.0–38.0)	25.0 (18.0–49.5)	1.000
ALT (U/L; median, IQR)	21.0 (12.0–33.5)	21.0 (14.0–32.0)	19.0 (11.5–36.0)	0.598
HBDH (U/L)	215.5±149.6	223.6±181.2	208.2±112.3	0.195
LDH (U/L)	302.6±311.8	328.7±373.5	277.4±137.6	0.606
HDL (mmol/L)	1.1±0.5	0.9±0.4	1.3±0.6	0.001
UA (mmol/L)	306.5±140.6	313.9±148.1	300.0±134.5	0.611
Coagulation tests
APTT (sec)	36.2±18.1	35.1±10.9	37.1±22.7	0.566
PT (sec; median, IQR)	13.8 (12.4–15.0)	14.2 (13.1–15.6)	13.2 (11.8–14.9)	0.088
Fb (g/L)	4.1±1.7	3.6±1.5	4.5±1.9	0.011

Notes: Continuous variables conforming to the normal distribution were represented by the mean ± standard deviation, and continuous variables not conforming to the normal distribution were represented by the median and its interquartile range (IQR).

Abbreviations: ALB, albumin; ALT, alanine aminotransferase; APTT, activated partial thromboplastin time; AOMI, arterial occlusive mesenteric ischemia; AST, aspartate aminotransferase; Fb, fibrinogen; HBDH, hydroxybutyrate dehydrogenase; HDL, high-density lipoprotein; LDH, lactate dehydrogenase; MVT, mesenteric venous thrombosis; NLR, neutrophil to lymphocyte ratio; PT, prothrombin time; UA, uric acid.

Table 4 Factors Effecting 30-Day Postoperative Mortality in the Patients with Obstructive AMI

	ALL (n = 77)	Alive (n = 54)	Dead (n = 23)	P
Demographic characteristics and major underlying comorbidities
Older age (≥ 60 years; %)	37 (48.1)	22 (40.7)	15 (65.2)	0.049
Male (%)	51 (66.2)	40 (74.1)	11 (47.8)	0.026
Weight (kg)	65.9±15.0	65.5±14.7	66.7±16.0	0.795
Cardiac disease (%)	15 (19.5)	7 (13.0)	8 (34.8)	0.058
Hypertension (%)	19 (24.7)	12 (22.2)	7 (30.4)	0.444
Diabetes (%)	9 (11.7)	9 (16.7)	0 (0)	0.090
Liver disease (%)	10 (13.0)	7 (13.0)	3 (13.0)	0.992
Peripheral vascular disease (%)	8 (10.4)	8 (14.8)	0 (0)	0.123
Abdominal surgery (%)	31 (40.3)	22 (40.7)	9 (39.1)	0.895
Clinical symptoms
Abdominal pain (%)	72 (93.5)	52 (96.3)	20 (87.0)	0.309
Vomiting (%)	11 (14.3)	6 (11.1)	5 (21.7)	0.223
Abdominal distension (%)	21 (27.3)	13 (24.1)	8 (34.8)	0.334
Diarrhea (%)	4 (5.2)	3 (5.6)	1 (4.3)	1.000
Bloody stools (%)	13 (15.6)	6 (11.1)	7 (30.4)	0.082
Physical findings
Abdominal tenderness (%)	60 (77.9)	43 (79.6)	17 (73.9)	0.580
Rebounding pain (%)	52 (67.5)	36 (66.7)	16 (69.6)	0.804
Muscle guarding (%)	48 (62.3)	33 (61.1)	15 (65.2)	0.734
Blood tests
WBC, mm^3	17,700±9471	17,600±9819	18,000±8804	0.891
Lymphocyte, %	7.3±5.2	7.6±5.2	6.5±5.1	0.402
NLR	18.5±15.8	18.2±17.1	19.2±12.3	0.804
Platelet (*10^9/L)	190±91	210±98	144±50	0.003
Biochemical tests
ALB (g/L)	35.6±6.0	35.6±6.1	35.7±5.8	0.904
AST (U/L; median, IQR)	24.0 (16.5–41.5)	22.0 (15.0–38.5)	24.0 (15.0–26.0)	0.982
ALT (U/L; median, IQR)	21.0 (11.0–29.0)	20.0 (10.8–31.3)	21.0 (15.0–26.0)	0.634
HBDH (U/L)	225.7±165.0	225.2±176.5	227.1±137.7	0.965
LDH (U/L)	317.6±359.2	328.0±416.7	292.9±159.0	0.710
HDL (mmol/L)	1.1±0.6	1.0±0.5	1.3±0.7	0.048
UA (umol/L)	306.4±144.1	307.1±161.3	304.9±94.9	0.952
Coagulation tests
APTT (sec)	36.0±20.2	34.6±13.4	39.4±31.0	0.340
PT (sec)	18.1±20.0	18.0±19.1	18.5±22.2	0.904
Fb (g/L)	3.7 (3.0–4.9)	3.6 (2.5–4.5)	4.0 (3.3–6.1)	0.117
Subtype of disease
AOMI (%)	45 (58.4)	27 (50.0)	18 (78.3)	0.021
Time interval from admission to surgery (hour)	9.4±5.2	8.1±4.0	12.5±6.3	0.001

Notes: Continuous variables conforming to the normal distribution were represented by the mean ± standard deviation, and continuous variables not conforming to the normal distribution were represented by the median and its interquartile range (IQR). Cardiac disease includes coronary heart disease, atrial fibrillation, and heart valve disease; Liver disease includes chronic hepatitis and cirrhosis.

Abbreviations: ALB, albumin; ALT, alanine aminotransferase; APTT, activated partial thromboplastin time; AOMI, arterial occlusive mesenteric ischemia; AST, aspartate aminotransferase; Fb, fibrinogen; HBDH, hydroxybutyrate dehydrogenase; HDL, high-density lipoprotein; LDH, lactate dehydrogenase; NLR, neutrophil to lymphocyte ratio; PT, prothrombin time; UA, uric acid.

Table 5 Independent Risk Factors of 30-Day Postoperative Mortality in the Patients with Obstructive AMI

	Adjusted OR
	OR (95% CI)	P
Time interval from admission to surgery	1.19 (1.07–1.34)	0.005
Platelet	0.98 (0.97–0.99)	0.008
AOMI	5.55 (1.36–22.55)	0.017

Abbreviations: AOMI, arterial occlusive mesenteric ischemia; OR, odds ratio; CI, confidence interval.

Table 6 Factors Effecting 30-Day Postoperative Mortality in the Patients with AOMI

	ALL (n = 45)	Alive (n = 27)	Dead (n = 18)	P
Demographic characteristics and major underlying comorbidities
Older age (≥ 60 years; %)	29 (64.4)	17 (63.0)	12 (66.7)	0.799
Male (%)	25 (55.6)	17 (63.0)	8 (44.4)	0.221
Weight (kg)	66.2±15.4	65.4±14.6	67.3±16.7	0.624
Cardiac disease (%)	14 (31.1)	7 (25.9)	7 (38.9)	0.357
Hypertension (%)	15 (33.3)	9 (33.3)	6 (33.3)	1.000
Diabetes (%)	7 (15.6)	7 (25.9)	0 (0)	0.053
Liver disease (%)	3 (6.7)	2 (7.4)	1 (5.6)	1.000
Peripheral vascular disease (%)	2 (4.4)	2 (7.4)	0 (0)	0.509
Abdominal surgery (%)	17 (37.8)	12 (44.4)	5 (37.8)	0.259
Clinical symptoms
Abdominal pain (%)	43 (95.6)	26 (96.3)	17 (94.4)	0.768
Vomiting (%)	10 (22.2)	5 (18.5)	5 (27.8)	0.714
Abdominal distension (%)	11 (24.4)	5 (18.5)	6 (33.3)	0.436
Diarrhea (%)	4 (8.9)	3 (11.1)	1 (5.6)	0.915
Bloody stools (%)	7 (15.6)	2 (7.4)	5 (27.8)	0.153
Physical findings
Abdominal tenderness (%)	37 (82.2)	22 (81.5)	15 (83.3)	1.000
Rebounding pain (%)	32 (71.1)	18 (66.7)	14 (77.8)	0.420
Muscle guarding (%)	31 (68.9)	18 (66.7)	13 (72.2)	0.693
Blood tests
WBC, mm^3	18,000±9628	17,000±10,130	19,400±8920	0.432
Lymphocyte, %	6.9±5.3	7.9±6.2	5.6±3.2	0.149
NLR	20.9±19.0	20.7±22.5	21.1±12.8	0.950
Platelet (*10^9/L)	181±71	206±76	144±44	0.003
Biochemical tests
ALB (g/L)	36.1±5.9	35.8±6.0	36.5±5.7	0.712
AST (U/L; median, IQR)	24.0 (17.0–50.5)	23.0 (15.0–38.0)	24.0 (19.0–54.5)	0.951
ALT (U/L; median, IQR)	19.0 (11.0–29.5)	16.0 (11.0–38.0)	21.5 (17.3–25.8)	0.301
HBDH (U/L)	222.1±121.1	206.3±96.0	245.8±151.6	0.318
LDH (U/L)	293.4±148.2	275.5±132.7	320.4±169.7	0.354
HDL (mmol/L)	1.3±0.6	1.2±0.5	1.4±0.7	0.298
UA (umol/L)	308.7±134.1	312.2±156.1	303.4±96.3	0.833
Coagulation tests
APTT (sec)	37.5±25.4	35.0±16.7	41.2±34.9	0.434
PT (sec)	20.5±25.8	21.1±26.7	19.6±25.2	0.855
Fb (g/L)	4.2±1.9	3.6±1.6	5.1±2.0	0.006
Time interval from admission to surgery (hour)	9.3±5.7	7.4±3.8	12.1±6.9	0.004

Notes: Continuous variables conforming to the normal distribution were represented by the mean ± standard deviation, and continuous variables not conforming to the normal distribution were represented by the median and its interquartile range (IQR). Cardiac disease includes coronary heart disease, atrial fibrillation, and heart valve disease; Liver disease includes chronic hepatitis and cirrhosis.

Abbreviations: ALB, albumin; ALT, alanine aminotransferase; APTT, activated partial thromboplastin time; AST, aspartate aminotransferase; Fb, fibrinogen; HBDH, hydroxybutyrate dehydrogenase; HDL, high-density lipoprotein; LDH, lactate dehydrogenase; NLR, neutrophil to lymphocyte ratio; PT, prothrombin time; UA, uric acid.

Table 7 Independent Risk Factors of 30-Day Postoperative Mortality in Patients with AOMI

	Adjusted OR
	OR (95% CI)	P
Time interval from admission to surgery	1.22 (1.01–1.47)	0.036
Platelet	0.98 (0.97–0.99)	0.020

Abbreviations: OR, odds ratio; CI, confidence interval.