European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024
Outcomes after open and endovascular treatment for mesenteric artery embolism patients: a retrospective inverse probability of treatment-weighted analysis.
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Qiu Yi-Hui, Zhang Yin-He, Wu Zi-Chang, Yang Zhe, Zhu Guan-Xia, Miao Shou-Liang, Chen Bi-Cheng, Chen Fan-Feng
Аннотация
PURPOSE: This study aims to evaluate outcomes in patients with mesenteric artery embolism (MAE) who received primary endovascular therapy (EVT) or laparotomy, and investigate risk factors for 30-day mortality.
METHODS: A retrospective analysis of 94 MAE patients who underwent two different treatment strategies was undertaken. An inverse probability of treatment weighting (IPTW) method was used to balance the confounding effects of baseline clinical data. Logistic regression analysis was performed to compare the outcomes according to type of treatment regimens before and after IPTW. Univariate and multivariable analysis were conducted to determine the risk factors for 30-day mortality.
RESULTS: Twenty-eight MAE patients received primary EVT, and 66 Open Surgery (OS). Logistic regression analysis showed that there was no significant difference between the EVT and OS group in 30-day mortality rate before (odds ratio [OR] 0.477, 95% confidence interval [CI] 0.170 to 1.340, P = 0.160), and after IPTW (OR 0.647, 95% CI 0.210 to 1.993, P = 0.449). After IPTW, it revealed that the rates of second-look surgery (OR 36.727, 95% CI 5.407 to 249.458, P < 0.001) and hospital stay [> 30 days] (OR 0.006, 95% CI 0.000 to 0.363, P = 0.014) were different in the two groups. D-dimer (> 4 mg/L) and procalcitonin (> 0.5 ng/mL) were the independent risk factors for 30-day mortality in MAE patients postoperatively (P < 0.05).
CONCLUSION: In this retrospective study, MAE patients who performed primary EVT had no obvious difference in 30-day mortality rate compared to those who received OS; but it was conducive to reducing prolonged hospital stays. An increase in procalcitonin level and higher D-dimer were associated with short-term poor prognosis in patients with MAE.
METHODS: A retrospective analysis of 94 MAE patients who underwent two different treatment strategies was undertaken. An inverse probability of treatment weighting (IPTW) method was used to balance the confounding effects of baseline clinical data. Logistic regression analysis was performed to compare the outcomes according to type of treatment regimens before and after IPTW. Univariate and multivariable analysis were conducted to determine the risk factors for 30-day mortality.
RESULTS: Twenty-eight MAE patients received primary EVT, and 66 Open Surgery (OS). Logistic regression analysis showed that there was no significant difference between the EVT and OS group in 30-day mortality rate before (odds ratio [OR] 0.477, 95% confidence interval [CI] 0.170 to 1.340, P = 0.160), and after IPTW (OR 0.647, 95% CI 0.210 to 1.993, P = 0.449). After IPTW, it revealed that the rates of second-look surgery (OR 36.727, 95% CI 5.407 to 249.458, P < 0.001) and hospital stay [> 30 days] (OR 0.006, 95% CI 0.000 to 0.363, P = 0.014) were different in the two groups. D-dimer (> 4 mg/L) and procalcitonin (> 0.5 ng/mL) were the independent risk factors for 30-day mortality in MAE patients postoperatively (P < 0.05).
CONCLUSION: In this retrospective study, MAE patients who performed primary EVT had no obvious difference in 30-day mortality rate compared to those who received OS; but it was conducive to reducing prolonged hospital stays. An increase in procalcitonin level and higher D-dimer were associated with short-term poor prognosis in patients with MAE.