Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study).

Autor: Reintam Blaser A; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia. annika.reintam.blaser@ut.ee.; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. annika.reintam.blaser@ut.ee., Mändul M; Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia.; Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia., Björck M; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden., Acosta S; Department of Clinical Sciences, Lund University, Malmö, Sweden., Bala M; Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Bodnar Z; Letterkenny University Hospital, Letterkenny, Ireland., Casian D; University Clinic of Vascular Surgery, 'Nicolae Testemitanu' State University of Medicine and Pharmacy of the Republic of Moldova, Chişinău, Moldova., Demetrashvili Z; N. Kipshidze Central University Hospital, Tbilisi, Georgia., D'Oria M; University Hospital of Trieste ASUGI, Trieste, Italy., Durán Muñoz-Cruzado V; Virgen del Rocío University Hospital, Seville, Spain., Forbes A; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia., Fuglseth H; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway., Hellerman Itzhaki M; Intensive Care Unit and Institute for Nutrition Research, Rabin Medical Center, University of Tel Aviv, Petah Tikva, Israel., Hess B; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland., Kase K; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.; Tartu University Hospital, Puusepa 8, Tartu, Estonia., Kirov M; Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University and City Hospital #1, Arkhangelsk, Russia., Lein K; University Hospital North Norway and UiT The Arctic University of Norway, Tromsö, Norway., Lindner M; Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany., Loudet CI; Hospital General San Martin de La Plata, Buenos Aires, Argentina., Mole DJ; Chair of Surgery, University of Edinburgh Centre for Inflammation Research, Royal Infirmary of Edinburgh, Edinburgh, UK., Murruste M; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.; Tartu University Hospital, Puusepa 8, Tartu, Estonia., Nuzzo A; Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, AP-HP. Nord, Beaujon Hospital, Paris Cité University, Paris, France., Saar S; Division of Acute Care Surgery, North Estonia Medical Centre, Tallinn, Estonia., Scheiterle M; Azienda Ospedaliera Universitaria Careggi, Florence, Italy., Starkopf J; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.; Tartu University Hospital, Puusepa 8, Tartu, Estonia., Talving P; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.; Division of Acute Care Surgery, North Estonia Medical Centre, Tallinn, Estonia., Voomets AL; Tartu University Hospital, Puusepa 8, Tartu, Estonia., Voon KKT; Colorectal Surgery, Sarawak General Hospital, Kuching, Malaysia., Yunus MA; General Surgeon of General Surgery Department, Hospital Melaka, Malacca, Malaysia., Tamme K; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.; Tartu University Hospital, Puusepa 8, Tartu, Estonia.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Jan 23; Vol. 28 (1), pp. 32. Date of Electronic Publication: 2024 Jan 23.
DOI: 10.1186/s13054-024-04807-4
Abstrakt: Background: The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI).
Methods: All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected.
Results: AMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1-12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied.
Conclusions: The overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management.
Trial Registration: NCT05218863 (registered 19.01.2022).
(© 2024. The Author(s).)
Databáze: MEDLINE
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