Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3625
Peer-review started: March 11, 2020
First decision: April 25, 2020
Revised: May 26, 2020
Accepted: June 9, 2020
Article in press: June 9, 2020
Published online: July 7, 2020
Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis as a result of irreversible intestinal ischemia. Emerging studies revealed that prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization and reverse early intestinal injury. However, irreversible intestinal ischemia still occurs in some cases.
Previous studies always involved both arterial and venous mesenteric ischemia. However, compared to arterial mesenteric ischemia, different pathophysiology is involved and it is more difficult to distinguish irreversible ischemia from viable bowels in venous mesenteric ischemia. What’s more, AMVT can not only cause intestinal necrosis in the short term but also result in intestinal stenosis in the long term, requiring intestinal resection. Limited to the rarity of AMVT, few studies have explored the predictive factors for irreversible intestinal ischemia, requiring surgical resection, in AMVT patients treated by TT.
This study aimed to identify predictive factors for irreversible intestinal ischemia in AMVT patients treated by TT.
We retrospectively analyzed the data of 58 AMVT patients who underwent TT. To identify the predictive factors, AMVT patients treated by TT were divided into two groups: Patients with irreversible intestinal ischemia and those with reversible intestinal ischemia. Then, group comparisons and a multivariate binary logistic regression analysis were performed.
Thirty-two (55.2%) patients with irreversible intestinal ischemia had a higher 30-d mortality and a longer in-hospital stay than patients with reversible intestinal injuries. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively.
Both total leukocyte count and APACHE II score are prognostic factors for irreversible intestinal ischemia in AMVT patients after initiation of TT.
Both total leukocyte count and APACHE II score are common clinical parameters that are easily available to clinicians upon admission, and may be valuable predictors to discriminate AMVT patients treated by TT who will suffer from irreversible intestinal ischemia from those who can be managed with conservative measures.