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

Intensive Care Medicine volume 41, pages 667–676 (2015)Cite this article

An Erratum to this article was published on 12 March 2015

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.

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Conflicts of interest

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

Author information

Authors and Affiliations

  1. Anesthesiology and Critical Care Department, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France

    Alexandra Piton

  2. Service de Reanimation, Hôpital d’Instruction des Armées Laveran, Marseille, France

    Eric Peytel

  3. Medical-surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d’Orléans, Orléans, France

    Kamel Toufik

  4. Service d’anesthésie reanimation, hospital Nord, CHU de Saint Etienne, Saint-priest-en-Jarez, France

    Marie-Charlotte Vogler

  5. Department of Anesthesia and Critical Care Medicine, Lyon-Sud Hospital, Hospices Civils de Lyon and University Lyon 1, Lyon, France

    Florent Wallet & Bernard Allaouchiche

  6. Service d’anesthésie et de réanimation, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France

    Marc Leone, Carole Bechis & Claude Martin

  7. Unité d’Aide Méthodologique à la Recherche Clinique et Epidémiologique, Aix Marseille Université, Marseille, France

    Karine Baumstarck

  8. CHU de Bordeaux, Service d’Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-Lévêque, Hôpital Haut Lévêque, Avenue Magellan, 33600, Pessac, France

    Alexandre Ouattara

  9. Pôle Anesthésie, Réanimation Chirurgicale, SAMU, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Olivier Collange

  10. Département d’Anesthésie Réanimation Chirurgicale, CHU Bichat Claude Bernard, 46 Rue Henri Huchard, Paris, France

    Pascal Augustin

  11. Department of Intensive Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France

    Djillali Annane

  12. University of Versailles, Montigny le Bretonneux, France

    Djillali Annane

  13. Réanimation Chirurgicale Polyvalente, Département d’Anesthésie et de Réanimation, Hôpital Pitié Salpétrière APHP, Paris, France

    Charlotte Arbelot

  14. Department of Anesthesiology and Critical Care, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes Cedex 1, France

    Karim Asehnoune

  15. Service de réanimation, Centre Hospitalier d’Aix-en-Provence, Aix-en-Provence, France

    Olivier Baldési

  16. Service de Réanimation, Centre Hospitalier de Cannes, Cannes, France

    Pierre-Marie Bertrand

  17. Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg, Saint-Jacques, Paris, France

    Simon Bourcier

  18. Département d’Anesthésie et de Réanimation, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France

    Nicolas Bruder

  19. Service de Réanimation Polyvalente, CH Henri Duffaut, 305, rue Raoul Follereau, Avignon Cedex09, France

    Laurence Delapierre

  20. Service Réanimation Polyvalente-USC, Hôpital Sainte Musse, Avenue Sainte Claire Deville, Toulon, France

    Didier Demory

  21. Department of Medical Intensive Care and Hyperbaric Medicine, University Hospital of Angers, 4 rue Larrey, Angers, France

    Emilie Friou

  22. Département d’anesthésie-réanimation, Hôpital Edouard Herriot, Place d’Arsonval, Lyon, France

    Baptiste Hengy & Thomas Rimmelé

  23. Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France

    Carole Ichai

  24. Surgical Critical Care Unit, Department of Anesthesiology and Critical Care, Lille University Teaching Hospital-CHU Lille, Lille, France

    Eric Kipnis & Etienne Brasdefer

  25. Medical Intensive Care Unit, CHU Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France

    Fanny Klasen

  26. Pôle d’anesthésie-réanimation, CHU d’Angers, 4, rue Larrey, Angers, France

    Sigismond Lasocki

  27. Service de Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France

    Jugurtha Aliane

  28. Department of Anesthesiology and Critical Care and SMUR and Burn Unit, Assistance Publique-Hôpitaux de Paris, GH St Louis Lariboisière, University of Paris 7 Denis Diderot, Paris, France

    Matthieu Legrand

  29. Service d’Anesthésie Réanimation, CHU de Poitiers, INSERM U1070, Université de Poitiers, Poitiers, France

    Olivier Mimoz

  30. Service de Réanimation Médicale Brabois, Hôpital Brabois, CHU Nancy, Vandoeuvre-Les-Nancy, France

    Bruno Lévy

  31. Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier University 1, Montpellier, France

    Oriane Martinez

  32. Département d’Anesthésie et de Réanimation, Hôpital la Conception, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France

    Elisa Richter

  33. Service de chirurgie vasculaire, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France

    Mourad Boufi

  34. Réanimation Adultes et Unité de Soins Continus, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, Clermont-Ferrand, France

    Jean-Michel Constantin

  35. Intensive Care Unit, Anaesthesia and Critical Care Dept B, Saint-Eloi Teaching Hospital, INSERM U1046, Montpellier 1 University, Montpellier, France

    Samir Jaber

  36. Services des Réanimations, Division Anesthésie Réanimation Douleur Urgence, CHU de Nîmes, place du Pr-Robert-Debré, Nîmes, France

    Jean-Yves Lefrant

Authors
  1. Marc Leone
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  2. Carole Bechis
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  3. Karine Baumstarck
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  4. Alexandre Ouattara
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  5. Olivier Collange
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  6. Pascal Augustin
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  7. Djillali Annane
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  8. Charlotte Arbelot
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  9. Karim Asehnoune
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  10. Olivier Baldési
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  11. Simon Bourcier
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  12. Laurence Delapierre
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  13. Didier Demory
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  14. Baptiste Hengy
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  15. Carole Ichai
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  16. Eric Kipnis
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  17. Etienne Brasdefer
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  18. Sigismond Lasocki
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  19. Matthieu Legrand
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  20. Olivier Mimoz
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  21. Thomas Rimmelé
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  22. Jugurtha Aliane
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  23. Pierre-Marie Bertrand
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  24. Nicolas Bruder
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  25. Fanny Klasen
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  26. Emilie Friou
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  27. Bruno Lévy
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  28. Oriane Martinez
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  29. Eric Peytel
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  30. Alexandra Piton
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  32. Kamel Toufik
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  33. Marie-Charlotte Vogler
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  34. Florent Wallet
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  35. Mourad Boufi
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  36. Bernard Allaouchiche
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  37. Jean-Michel Constantin
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  38. Claude Martin
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  39. Samir Jaber
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  40. Jean-Yves Lefrant
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Corresponding author

Correspondence to Marc Leone.

Additional information

Take-home message: Acute mesenteric ischemia was associated with a 58 % death rate in ICU patients. Age and severity score at diagnosis were risk factors for mortality; plasma lactate concentration above 2.7 mmol/l was also an independent risk factor.

For the AtlanRea and AzuRea Collaborative Network Investigators; members are listed in the “Appendix”.

Electronic supplementary material

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Appendix: List of investigators

Appendix: List of investigators

Pierre Asfar, Johan Auchabie (Hôpital Universitaire d’Angers), Gaston Grossmith (Centre Hospitalier Edmond Garcin, Aubagne), Pierre Courant (Centre Hospitalier d’Avignon), Jean-Luc Fellahi (Centre Hospitalo-Universitaire de Caen), Mélanie Tari, Bertrand Souweine (Centre Hospitalier de Clermont Ferrand), Pierre Visintini (Centre Hospitalier Interrégional des Alpes du Sud, Gap), Tarek Sharshar (Hôpital Raymond Poincaré, Montigny le Bretonneux), Vincent Piriou (Hospices Civils de Lyon), Djamel Mokart (Institut Paoli-Calmettes, Marseille), Sandrine Wiramus, Jacques Albanèse (Hôpital la Conception, Marseille), Alexandre Marillier, Nicolas Bruder (Hôpital la Timone, Marseille), Sami Hraiech, Laurent Papazian (Réanimation DRIS, Hôpital Nord, Marseille), Claire Contargyris (Hôpital Laveran, Marseille), Xavier Capdevila (Hôpital Lapeyronie, Montpellier), Julien Darmian (CHU Nancy Hôpital Central), Loubna Elotmani (Hôpital Carremeau, Nîmes), Thierry Boulain (Hôpital de la Source, Orléans), Philippe Montravers (Hôpital Bichat, Paris), Jean-Paul Mira, Frédéric Pene (Hôpital Cochin, Paris), Olivier Langeron (Hôpital la Pitié Salpétrière, Paris), Matthieu Legrand (Hôpital Saint Louis, Paris), Dorothé Balayn, Sabrina Seguin (CHU de Poitiers), Ali Mofredj (Centre Hospitalier de Salon), Marie-Charlotte Vogler, Serge Molliex (CHU Saint Etienne), Olivier Fourcade, Thomas Geeraerts (CHU Toulouse).

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Leone, M., Bechis, C., Baumstarck, K. et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med 41, 667–676 (2015). https://doi.org/10.1007/s00134-015-3690-8

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Keywords

  • Ischemia
  • Mesenteric
  • Occlusion
  • Lactate
  • Surgery