Original Paper

New Prediction Rule for Mortality in Acute Mesenteric Ischemia
Yoshio Haga^a, Masaharu Odo^a, Masato Homma^b, Kenichi Komiya^c, Kazunori Takeda^d, Shoichiro Koike^e, Tadateru Takahashi^f, Kiyohisa Hiraka^g, Haruhiro Yamashita^h, Kohji Tanakaya<sup>i

a</sup>Department of Surgery, National Hospital Organization (NHO) Kumamoto Medical Center, Kumamoto,
^bDepartment of Emergency Care, NHO National Disaster Medical Center, and
^cDepartment of Gastroenterology, NHO Tokyo Medical Center, Tokyo,
^dDepartment of Surgery, NHO Sendai Medical Center, Sendai,
^eDepartment of Surgery, NHO Matsumoto Medical Center, Matsumoto,
^fDepartment of Surgery, NHO Higashihiroshima Medical Center, Higashihiroshima,
^gDepartment of Radiology, NHO Kyushu Medical Center, Fukuoka,
^hDepartment of Gastroenterology, NHO Okayama Medical Center, Okayama, and
ⁱDepartment of Surgery, NHO Iwakuni Clinical Center, Iwakuni, Japan

Address of Corresponding Author

Digestion 2009;80:104-111 (DOI: 10.1159/000219367)

  Key Words

• Intestine
• Mesentery
• Ischemia

  Abstract

Objective: Acute mesenteric ischemia is potentially fatal, but prognostic factors have not yet been established. This study was undertaken to elucidate them. Methods: This is a retrospective cohort study, consisting of 110 patients who had been treated in the past 5 years, from 26 national hospitals in Japan. Results: The overall in-hospital mortality rate was 51%. Logistic regression analysis demonstrated two independent prognostic factors, electrocardiogram scale with an odds ratio of 1.7 (95% CI 1.2–2.4) and shock index of 11 (95% CI 1.5–80). A stepwise analysis gave a prediction equation for in-hospital mortality (R) using these variables and age score. We further modified this equation to a simpler scoring system (S) using the same variables. Both R and S showed a good discriminatory ability as determined by areas under the receiver-operating characteristic curve (0.83, 95% CI: 0.74–0.91 for R; 0.82, 95% CI 0.74–0.91 for S). The observed mortality rates increased as the R or S increased (19% at R <0.25, 41% at 0.25 ≤ R <0.6, 85% at R ≥0.6; 19% at S ≤2, 37% at S of 3 or 4, 91% at S ≥5). Conclusion: The new prediction rules can be used at any hospital and may be promising tools for medical decision-making, informed consent and reviewing quality of care.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Yoshio Haga, MD
Department of Surgery, National Hospital Organization (NHO)
Kumamoto Medical Center
1-5 Ninomaru, Kumamoto 8600008 (Japan)
Tel. +81 96 353 6501, Fax +81 96 325 2519, E-Mail epass2006@yahoo.co.jp

  Article Information

Received: November 11, 2008
Accepted: April 30, 2009
Published online: June 26, 2009
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 5, Number of References : 26