Diagnostic and Prognostic Factors in Acute Intestinal Ischemia: A Comparative, Retrospective, Single-Center Cohort Study
Journal of Clinical Medicine, cilt.15, sa.16, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 15 Sayı: 16
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/jcm15166157
- Dergi Adı: Journal of Clinical Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, EMBASE, Academic Search Ultimate (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: acute mesenteric ischemia, Mannheim peritonitis index, APACHE-II, neutrophil-to-lymphocyte ratio, arterial lactate, prognosis
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background/Objectives: Acute mesenteric ischemia (AMI) resembles non-vascular intestinal ischemia (NSII) and non-specific abdominal pain (NSAP) at presentation yet carries 50–80% mortality. We tested how well admission data separate these conditions and predict in-hospital mortality, the primary endpoint. Methods: We studied 197 consecutive adults (2015–2021): AMI (n = 61), NSII (n = 62), and NSAP controls (n = 74). Admission demographics, comorbidities, laboratory markers, the Mannheim Peritonitis Index (MPI), and APACHE-II were compared by ROC/DeLong analysis and multivariable logistic regression (STROBE). Results: AMI had more atrial fibrillation, thromboembolism, chronic kidney disease (CKD), and dyslipidemia (p ≤ 0.028) and higher in-hospital mortality than NSII (47.5% vs. 16.1%; p < 0.001). Inflammatory ratios, lactate, and albumin separated AMI from NSAP well (AUC up to 0.93) but from NSII modestly (lactate, 0.672). APACHE-II (AUC 0.861) and MPI (0.810) predicted in-hospital death and improved combined (0.897; DeLong p = 0.014). Independent predictors were MPI (adjusted odds ratio 1.14, 95% CI 1.06–1.23), CKD (3.72, 1.25–12.10), and arterial lactate (1.20, 1.03–1.45). Conclusions: A composite admission panel was internally consistent but hypothesis-generating, not a triage tool ready for clinical use. CT angiography remains essential, since these markers cannot separate vascular from non-vascular ischemia; prospective external validation is required.