Clinical factors and outcomes in patients with acute mesentric ischemia in the emergency department

Hsien Hao Huang, Yu Che Chang, David Hung Tsang Yen, Wei Fong Kao, Jen Dar Chen, Lee Min Wang, Chun I. Huang, Chen Hsen Lee

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). Methods: The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 were reviewed retrospectively to obtain data about demographics, initial clinical presentations, predisposing diseases, previous medications, laboratory tests, and common findings on computed tomography scans with contrast. Only patients admitted through the ED and treated on medical or surgical wards were enrolled. Results: Mean patient age was 71.1 years (range, 25-100 years). The overall mortality rate was 50%. There were no significant differences in gender, underlying disease, previous medication, initial signs and symptoms, and causes of mesenteric infarction, between survivors and non-survivors. Univariate analysis demonstrated that older age, bandemia, hepatic and renal impairment, hyperamylasemia, metabolic acidosis, hypoxia, intramural pneumatosis, and septic syndrome, were more frequent in patients who died than in those who survived (p <0.05). Logistic regression identified the following variables as independent predictors of death: old age (odds ratio, OR, 1.077; 95% confidence interval, CI 1.013, 1.146; p = 0.02); bandema (OR, 3.894; 95% CI, 1.160, 13.074; p = 0.03); elevated serum aspartate aminotransferase (AST; OR, 4.532; 95% CI, 1.274, 16.122; p = 0.02); increased blood urea nitrogen (BUN; OR, 7.219; 95% CI, 1.166, 44.696; p = 0.03); and metabolic acidosis (OR, 6.604; 95% CI, 1.804, 24.171; p <0.01). Conclusion: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.

Original languageEnglish
Pages (from-to)299-306
Number of pages8
JournalJournal of the Chinese Medical Association
Volume68
Issue number7
Publication statusPublished - Jul 2005
Externally publishedYes

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Hospital Emergency Service
Ischemia
Blood Urea Nitrogen
Acidosis
Hyperamylasemia
Mortality
Diagnostic Imaging
Aspartate Aminotransferases
Infarction
Signs and Symptoms
Survivors
Early Diagnosis
Logistic Models
Odds Ratio
Tomography
Demography
Confidence Intervals
Kidney
Mesenteric Ischemia
Liver

Keywords

  • Emergency department
  • Mesentric ischemia
  • Outcomes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Huang, H. H., Chang, Y. C., Yen, D. H. T., Kao, W. F., Chen, J. D., Wang, L. M., ... Lee, C. H. (2005). Clinical factors and outcomes in patients with acute mesentric ischemia in the emergency department. Journal of the Chinese Medical Association, 68(7), 299-306.

Clinical factors and outcomes in patients with acute mesentric ischemia in the emergency department. / Huang, Hsien Hao; Chang, Yu Che; Yen, David Hung Tsang; Kao, Wei Fong; Chen, Jen Dar; Wang, Lee Min; Huang, Chun I.; Lee, Chen Hsen.

In: Journal of the Chinese Medical Association, Vol. 68, No. 7, 07.2005, p. 299-306.

Research output: Contribution to journalArticle

Huang, HH, Chang, YC, Yen, DHT, Kao, WF, Chen, JD, Wang, LM, Huang, CI & Lee, CH 2005, 'Clinical factors and outcomes in patients with acute mesentric ischemia in the emergency department', Journal of the Chinese Medical Association, vol. 68, no. 7, pp. 299-306.
Huang, Hsien Hao ; Chang, Yu Che ; Yen, David Hung Tsang ; Kao, Wei Fong ; Chen, Jen Dar ; Wang, Lee Min ; Huang, Chun I. ; Lee, Chen Hsen. / Clinical factors and outcomes in patients with acute mesentric ischemia in the emergency department. In: Journal of the Chinese Medical Association. 2005 ; Vol. 68, No. 7. pp. 299-306.
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abstract = "Background: The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). Methods: The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 were reviewed retrospectively to obtain data about demographics, initial clinical presentations, predisposing diseases, previous medications, laboratory tests, and common findings on computed tomography scans with contrast. Only patients admitted through the ED and treated on medical or surgical wards were enrolled. Results: Mean patient age was 71.1 years (range, 25-100 years). The overall mortality rate was 50{\%}. There were no significant differences in gender, underlying disease, previous medication, initial signs and symptoms, and causes of mesenteric infarction, between survivors and non-survivors. Univariate analysis demonstrated that older age, bandemia, hepatic and renal impairment, hyperamylasemia, metabolic acidosis, hypoxia, intramural pneumatosis, and septic syndrome, were more frequent in patients who died than in those who survived (p <0.05). Logistic regression identified the following variables as independent predictors of death: old age (odds ratio, OR, 1.077; 95{\%} confidence interval, CI 1.013, 1.146; p = 0.02); bandema (OR, 3.894; 95{\%} CI, 1.160, 13.074; p = 0.03); elevated serum aspartate aminotransferase (AST; OR, 4.532; 95{\%} CI, 1.274, 16.122; p = 0.02); increased blood urea nitrogen (BUN; OR, 7.219; 95{\%} CI, 1.166, 44.696; p = 0.03); and metabolic acidosis (OR, 6.604; 95{\%} CI, 1.804, 24.171; p <0.01). Conclusion: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.",
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AU - Huang, Hsien Hao

AU - Chang, Yu Che

AU - Yen, David Hung Tsang

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AU - Chen, Jen Dar

AU - Wang, Lee Min

AU - Huang, Chun I.

AU - Lee, Chen Hsen

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N2 - Background: The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). Methods: The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 were reviewed retrospectively to obtain data about demographics, initial clinical presentations, predisposing diseases, previous medications, laboratory tests, and common findings on computed tomography scans with contrast. Only patients admitted through the ED and treated on medical or surgical wards were enrolled. Results: Mean patient age was 71.1 years (range, 25-100 years). The overall mortality rate was 50%. There were no significant differences in gender, underlying disease, previous medication, initial signs and symptoms, and causes of mesenteric infarction, between survivors and non-survivors. Univariate analysis demonstrated that older age, bandemia, hepatic and renal impairment, hyperamylasemia, metabolic acidosis, hypoxia, intramural pneumatosis, and septic syndrome, were more frequent in patients who died than in those who survived (p <0.05). Logistic regression identified the following variables as independent predictors of death: old age (odds ratio, OR, 1.077; 95% confidence interval, CI 1.013, 1.146; p = 0.02); bandema (OR, 3.894; 95% CI, 1.160, 13.074; p = 0.03); elevated serum aspartate aminotransferase (AST; OR, 4.532; 95% CI, 1.274, 16.122; p = 0.02); increased blood urea nitrogen (BUN; OR, 7.219; 95% CI, 1.166, 44.696; p = 0.03); and metabolic acidosis (OR, 6.604; 95% CI, 1.804, 24.171; p <0.01). Conclusion: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.

AB - Background: The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). Methods: The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 were reviewed retrospectively to obtain data about demographics, initial clinical presentations, predisposing diseases, previous medications, laboratory tests, and common findings on computed tomography scans with contrast. Only patients admitted through the ED and treated on medical or surgical wards were enrolled. Results: Mean patient age was 71.1 years (range, 25-100 years). The overall mortality rate was 50%. There were no significant differences in gender, underlying disease, previous medication, initial signs and symptoms, and causes of mesenteric infarction, between survivors and non-survivors. Univariate analysis demonstrated that older age, bandemia, hepatic and renal impairment, hyperamylasemia, metabolic acidosis, hypoxia, intramural pneumatosis, and septic syndrome, were more frequent in patients who died than in those who survived (p <0.05). Logistic regression identified the following variables as independent predictors of death: old age (odds ratio, OR, 1.077; 95% confidence interval, CI 1.013, 1.146; p = 0.02); bandema (OR, 3.894; 95% CI, 1.160, 13.074; p = 0.03); elevated serum aspartate aminotransferase (AST; OR, 4.532; 95% CI, 1.274, 16.122; p = 0.02); increased blood urea nitrogen (BUN; OR, 7.219; 95% CI, 1.166, 44.696; p = 0.03); and metabolic acidosis (OR, 6.604; 95% CI, 1.804, 24.171; p <0.01). Conclusion: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.

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