Analysis of incidence and the value of SOFA and MOD scoring in predicting the outcome in acute mesenteric ischemia

Authors

  • Rajasenthil Viswanathan Department of Surgery, Sri Ramachandra University, Porur, Chennai
  • Santosh Vivekanandan L. Department of Surgery, Sri Ramachandra University, Porur, Chennai
  • Ravi A. Department of Surgery, Sri Ramachandra University, Porur, Chennai

DOI:

https://doi.org/10.18203/2349-2902.isj20150682

Keywords:

Acute mesenteric ischemia, SOFA, MOD

Abstract

Background: Acute mesenteric ischemia (AMI) is defined as a sudden loss of blood supply to visceral tissue, and it potentially results in intestinal infarction. AMI is an uncommon (1-2 per 1000 hospital admissions) but highly complex clinical problem. Mortality from AMI remains high despite an aggressive approach consisting of early diagnosis, restoration of arterial perfusion, resection of nonviable intestine, second-look laparotomy, and supportive intensive care with an average from published reports ranging from 30% to 65%. Moreover, most series have not shown any improvement in mortality over the last 2 decades, regardless of the therapeutic approach applied. While major advances in the technology and availability of imaging modalities have made earlier diagnosis and treatment more feasible, this has been counterbalanced by the contemporary AMI patient presenting at an advanced age and with more severe underlying comorbidities. Likewise, mesenteric ischemia remains a highly morbid condition. According to the literatures, early diagnosis, resection of the unviable bowel, recovery of adequate blood flow, second-look laparotomy, and supportive intensive management are the basis of appropriate management. 
Methods: The aim of the study was to analyse the incidence of AMI in our institution during April 2011– September 2013 and to study the demographics of that population and to compare the efficacy of SOFA vs MOD scoring in predicting the outcome of the patient with AMI. Treatment, consisting of surgical embolectomy or bypass grafting, has also yielded only modest improvements; some have championed an endovascular-first treatment paradigm. Moreover, accurate perioperative assessment of the risk of in-hospital mortality in patients with AMI is poorly defined.
Results: In our study 60.7% of the patients presented to the casualty within 24hrs of symptoms. Patients who presented later than 24hrs (39.3%) had a higher mortality rate of 60.7%.When SOFA score increased to greater than 13 all patients succumbed to the disease with a mortality of 100% in the groups with SOFA score 13-16 and 17-20. When MOD score increased to greater than 12 all patients succumbed to the disease with a mortality of 100% in the groups with MOD score 13-16 and 17-20. On comparing the predictive outcome of SOFA vs MOD scoring system, both had similar results in predicting mortality (p value < 0.0001).
Conclusions: To conclude, both SOFA and MOD scoring systems have similar values in predicting mortality for acute mesenteric ischemia. Other considerations such as age, comorbid illness DM /HTN/ /CAD /CVA do influence the outcome.

References

Schoots IG, Koffeman GI, Legemate DA, et al. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg. 2004;91(1):17-27. [DOI via Crossref] [Pubmed]

Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229(1):91-8. [DOI via Crossref] [Pubmed]

Chou CK, Mak CW, Tzeng WS, et al; CT of small bowel ischemia. Abdom Imaging. 2004;29(1):18-22. [DOI via Crossref] [Pubmed]

Shih MC, Hagspiel KD. CTA and MRA in mesenteric ischemia: part 1, role in diagnosis and differential diagnosis. Am J Roentgenol. 2007;188(2):452-61. [DOI via Crossref] [Pubmed]

Falkensammer J, Oldenburg WA. Surgical and medical management of mesenteric ischemia. Curr Treat Options Cardiovascu Med. 2006;8(2):137-43. [DOI via Crossref]

Sharafuddin MJ, Olson CH, Sun S, et al. Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results. J Vasc Surg. 2003;38(4):692-8. [DOI via Crossref]

Anadol AZ, Ersoy E, Taneri F, et al. Laparoscopic ''second-look'' in the management of mesenteric ischemia. Surg Laparosc Endosc Percutan Tech. 2004;14(4):191-3. [DOI via Crossref] [Pubmed]

Kaminsky O, Yampolski I, Aranovich D, et al. Does a second-look operation improve survival in patients with peritonitis due to acute mesenteric ischemia? A five-year retrospective experience. World J Surg. 2005;29(5):645-8. [DOI via Crossref] [Pubmed]

Hariharan S, Zbar A. Risk scoring in perioperative and surgical intensive care patients: a review. Cur Surg. 2006;63:226-36. [DOI via Crossref] [Pubmed]

Hsu HP, Shan YS, Hsieh YH, Sy ED, Lin PW; Impact of etiologic factors and APACHE II and POSSUM scores in management and clinical outcome of acute intestinal ischemic disorders after surgical treatment. World J Surg. 2006;30:2152-62. [DOI via Crossref] [Pubmed]

Schoots IG, Levi MM, Reekers JA, et al. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005;16(3):317-29. [DOI via Crossref] [Pubmed]

Park JH, Jeong SH, Kwag SJ, Park TJ, Jeong CY, Ju YT, et al. Identification of Prognostic Factors for Mortality in Acute Mesenteric Ischemia. Korean J Vasc Endovasc Surg. 2012;28(3):133-41. [DOI via Crossref]

Ryer EJ, Kalra M, Oderich GS, Duncan AA, Gloviczki P, Cha S, Bower TC. Revascularization for acute mesenteric ischemia. J Vasc Surg. 2012;55:1682-9. [DOI via Crossref] [Pubmed]

Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8. [DOI via Crossref] [Pubmed]

Ritz JP, Germer CT, Buhr HJ. Prognostic factors for mesenteric infarction: multivariate analysis of 187 patients with regard to patient age. Ann Vasc Surg. 2005;19:328-34. [DOI via Crossref] [Pubmed]

Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;256:93-101. [DOI via Crossref] [Pubmed]

Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2010;23:9-20. [DOI via Crossref] [Pubmed]

Acosta S, Ogren M, Sternby NH, et al. Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery da population-based study. Eur J Vasc Endovasc Surg. 2004;27(2):145-50. [DOI via Crossref] [Pubmed]

Park WM, Gloviczki P, Cherry KJ Jr, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35(3):445–52. [DOI via Crossref] [Pubmed]

Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46:467-74. [DOI via Crossref] [Pubmed]

Arthurs ZM, Titus J, Bannazadeh M, Eagleton MJ, Srivastava S, Sarac TP, et al. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg. 2011;53:698-705. [DOI via Crossref] [Pubmed]

Downloads

Published

2016-12-14

Issue

Section

Original Research Articles