Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study.
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Murata Takaaki, Yamaguchi Nobuo, Shimomoto Yutaro, Mikajiri Yumi, Sasaki Yuki, Konagaya Kensuke, Igarashi Yuto, Sawamura Naoki, Yamamoto Kota, Kume Nao, Suno Yuma, Kurata Shuji, Kasetani Tetsuya, Kato Ichiro, Nishida Tomoki, Hirata Hirohisa, Miyake Katsunori, Oonishi Takahisa, Isogai Naoko, Fukai Ryuta, Kanomata Hiroyuki, Shimoyama Rai, Kashiwagi Hiroyuki, Takenoue Tomohiro, Terashima Takahiro, Murayama Hiroyuki, Kohriki Shunsaku, Morita Takeshi, Takaki Mutsuo, Ogino Hidemitsu, Kanemaru Takayuki, Sano Ken, Kurogi Norimitsu, Watanabe Kazunao, Hirata Masahiro, Kawachi Jun
Аннотация
MATERIALS AND METHODS: In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors.
RESULTS: Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10.
CONCLUSION: This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.