Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2020; 26(25): 3625-3637
Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3625
Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis
Shi-Long Sun, Xin-Yu Wang, Cheng-Nan Chu, Bao-Chen Liu, Qiu-Rong Li, Wei-Wei Ding
Shi-Long Sun, Xin-Yu Wang, Cheng-Nan Chu, Bao-Chen Liu, Qiu-Rong Li, Wei-Wei Ding, Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Sun SL designed the study, collected the data, and wrote the manuscript; Wang XY and Chu CN performed data collection; Liu BC and Li QR were involved in data analysis; Ding WW made substantial contributions to the conception, design, funding acquisition, and coordination of the study and gave final approval of the version to be published; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81770532; Jiangsu Province Medical Foundation for Youth Talents, China, No. QNRC2016901.
Institutional review board statement: This study was approved by the Ethics Committee of the Affiliated Jinling Hospital, Medical School of Nanjing University.
Informed consent statement: All involved subjects gave their informed consent (verbal) prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at dingwei_nju@hotmail.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Wei Ding, MD, PhD, Doctor, Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305, East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. dingwei_nju@hotmail.com
Received: March 11, 2020
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

This study aimed to identify predictive factors for irreversible intestinal ischemia in AMVT patients treated by TT.

Research methods

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.

Research results

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.

Research conclusions

Both total leukocyte count and APACHE II score are prognostic factors for irreversible intestinal ischemia in AMVT patients after initiation of TT.

Research perspectives

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.