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Intensive Care Medicine

, Volume 41, Issue 4, pp 667–676 | Cite as

Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases

  • Marc Leone
  • Carole Bechis
  • Karine Baumstarck
  • Alexandre Ouattara
  • Olivier Collange
  • Pascal Augustin
  • Djillali Annane
  • Charlotte Arbelot
  • Karim Asehnoune
  • Olivier Baldési
  • Simon Bourcier
  • Laurence Delapierre
  • Didier Demory
  • Baptiste Hengy
  • Carole Ichai
  • Eric Kipnis
  • Etienne Brasdefer
  • Sigismond Lasocki
  • Matthieu Legrand
  • Olivier Mimoz
  • Thomas Rimmelé
  • Jugurtha Aliane
  • Pierre-Marie Bertrand
  • Nicolas Bruder
  • Fanny Klasen
  • Emilie Friou
  • Bruno Lévy
  • Oriane Martinez
  • Eric Peytel
  • Alexandra Piton
  • Elisa Richter
  • Kamel Toufik
  • Marie-Charlotte Vogler
  • Florent Wallet
  • Mourad Boufi
  • Bernard Allaouchiche
  • Jean-Michel Constantin
  • Claude Martin
  • Samir Jaber
  • Jean-Yves Lefrant
Original

Abstract

Background

In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.

Methods

A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.

Results

The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.

Conclusion

Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.

Keywords

Ischemia Mesenteric Occlusion Lactate Surgery 

Notes

Conflicts of interest

The authors have no conflict of interest to disclose related to this topic.

Supplementary material

134_2015_3690_MOESM1_ESM.docx (117 kb)
Supplementary material 1 (DOCX 116 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Marc Leone
    • 6
  • Carole Bechis
    • 6
  • Karine Baumstarck
    • 7
  • Alexandre Ouattara
    • 8
  • Olivier Collange
    • 9
  • Pascal Augustin
    • 10
  • Djillali Annane
    • 11
    • 12
  • Charlotte Arbelot
    • 13
  • Karim Asehnoune
    • 14
  • Olivier Baldési
    • 15
  • Simon Bourcier
    • 17
  • Laurence Delapierre
    • 19
  • Didier Demory
    • 20
  • Baptiste Hengy
    • 22
  • Carole Ichai
    • 23
  • Eric Kipnis
    • 24
  • Etienne Brasdefer
    • 24
  • Sigismond Lasocki
    • 26
  • Matthieu Legrand
    • 28
  • Olivier Mimoz
    • 29
  • Thomas Rimmelé
    • 22
  • Jugurtha Aliane
    • 27
  • Pierre-Marie Bertrand
    • 16
  • Nicolas Bruder
    • 18
  • Fanny Klasen
    • 25
  • Emilie Friou
    • 21
  • Bruno Lévy
    • 30
  • Oriane Martinez
    • 31
  • Eric Peytel
    • 2
  • Alexandra Piton
    • 1
  • Elisa Richter
    • 32
  • Kamel Toufik
    • 3
  • Marie-Charlotte Vogler
    • 4
  • Florent Wallet
    • 5
  • Mourad Boufi
    • 33
  • Bernard Allaouchiche
    • 5
  • Jean-Michel Constantin
    • 34
  • Claude Martin
    • 6
  • Samir Jaber
    • 35
  • Jean-Yves Lefrant
    • 36
  1. 1.Anesthesiology and Critical Care Department, University Hospital of ToulouseUniversity Toulouse 3 Paul SabatierToulouseFrance
  2. 2.Service de ReanimationHôpital d’Instruction des Armées LaveranMarseilleFrance
  3. 3.Medical-surgical Intensive Care Unit, Hôpital de La SourceCentre Hospitalier Régional d’OrléansOrléansFrance
  4. 4.Service d’anesthésie reanimation, hospital NordCHU de Saint EtienneSaint-priest-en-JarezFrance
  5. 5.Department of Anesthesia and Critical Care Medicine, Lyon-Sud HospitalHospices Civils de Lyon and University Lyon 1LyonFrance
  6. 6.Service d’anesthésie et de réanimation, hôpital NordAssistance Publique Hôpitaux de Marseille, Aix Marseille UniversitéMarseilleFrance
  7. 7.Unité d’Aide Méthodologique à la Recherche Clinique et EpidémiologiqueAix Marseille UniversitéMarseilleFrance
  8. 8.CHU de Bordeaux, Service d’Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-LévêqueHôpital Haut LévêquePessacFrance
  9. 9.Pôle Anesthésie, Réanimation Chirurgicale, SAMUHôpitaux Universitaires de StrasbourgStrasbourgFrance
  10. 10.Département d’Anesthésie Réanimation ChirurgicaleCHU Bichat Claude BernardParisFrance
  11. 11.Department of Intensive Care MedicineRaymond Poincaré Hospital, Assistance Publique-Hôpitaux de ParisGarchesFrance
  12. 12.University of VersaillesMontigny le BretonneuxFrance
  13. 13.Réanimation Chirurgicale Polyvalente, Département d’Anesthésie et de RéanimationHôpital Pitié Salpétrière APHPParisFrance
  14. 14.Department of Anesthesiology and Critical CareHôtel DieuNantes Cedex 1France
  15. 15.Service de réanimationCentre Hospitalier d’Aix-en-ProvenceAix-en-ProvenceFrance
  16. 16.Service de RéanimationCentre Hospitalier de CannesCannesFrance
  17. 17.Medical Intensive Care Unit, Cochin HospitalGroupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de ParisParisFrance
  18. 18.Département d’Anesthésie et de Réanimation, Hôpital la Timone, Assistance Publique Hôpitaux de MarseilleAix Marseille UniversitéMarseilleFrance
  19. 19.Service de Réanimation PolyvalenteCH Henri DuffautAvignon Cedex09France
  20. 20.Service Réanimation Polyvalente-USCHôpital Sainte MusseToulonFrance
  21. 21.Department of Medical Intensive Care and Hyperbaric MedicineUniversity Hospital of AngersAngersFrance
  22. 22.Département d’anesthésie-réanimationHôpital Edouard HerriotLyonFrance
  23. 23.Réanimation médico-chirurgicale, Hôpital Saint-RochCHU de NiceNiceFrance
  24. 24.Surgical Critical Care Unit, Department of Anesthesiology and Critical CareLille University Teaching Hospital-CHU LilleLilleFrance
  25. 25.Medical Intensive Care Unit, CHU NordAssistance Publique Hôpitaux de Marseille, Aix Marseille UniversityMarseilleFrance
  26. 26.Pôle d’anesthésie-réanimationCHU d’AngersAngersFrance
  27. 27.Service de Réanimation Médicale, Hôpital Gabriel MontpiedCHU de Clermont-FerrandClermont-FerrandFrance
  28. 28.Department of Anesthesiology and Critical Care and SMUR and Burn Unit, Assistance Publique-Hôpitaux de Paris, GH St Louis LariboisièreUniversity of Paris 7 Denis DiderotParisFrance
  29. 29.Service d’Anesthésie Réanimation, CHU de PoitiersINSERM U1070, Université de PoitiersPoitiersFrance
  30. 30.Service de Réanimation Médicale Brabois, Hôpital BraboisCHU NancyVandoeuvre-Les-NancyFrance
  31. 31.Department of Anesthesiology and Critical Care Medicine, Lapeyronie University HospitalMontpellier University 1MontpellierFrance
  32. 32.Département d’Anesthésie et de Réanimation, Hôpital la Conception, Assistance Publique Hôpitaux de MarseilleAix Marseille UniversitéMarseilleFrance
  33. 33.Service de chirurgie vasculaire, hôpital Nord, Assistance Publique Hôpitaux de MarseilleAix Marseille UniversitéMarseilleFrance
  34. 34.Réanimation Adultes et Unité de Soins Continus, CHU EstaingCHU Clermont-FerrandClermont-FerrandFrance
  35. 35.Intensive Care Unit, Anaesthesia and Critical Care Dept B, Saint-Eloi Teaching HospitalINSERM U1046, Montpellier 1 UniversityMontpellierFrance
  36. 36.Services des Réanimations, Division Anesthésie Réanimation Douleur UrgenceCHU de NîmesNîmesFrance

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