Predictors of bowel necrosis in patients with acute mesenteric ischemia: systematic review and meta-analysis.
Sameh Hany EmileSualeh Muslim KhanSamer Hani BarsoumPublished in: Updates in surgery (2020)
Acute mesenteric ischemia (AMI) is a serious medical condition that can progress to transmural bowel necrosis. Prediction of the onset of bowel necrosis in AMI is crucial to justify surgical intervention before more severe consequences supervene. This systematic review aimed to identify the significant predictors of bowel necrosis in AMI in the current literature. In adherence to the PRISMA guidelines, electronic databases were searched for studies that reported significant independent predictors of bowel necrosis in AMI. The quality of the studies was assessed with MINORS score. The main outcomes of the review were the incidence and predictors of bowel necrosis in patients with AMI and the mortality rate. This systematic review comprised nine articles that included 963 patients of a median age of 57 years. Irreversible bowel necrosis was found in 402 (41.7%) patients. The significant predictors of bowel necrosis were subdivided into eight clinical, seven biochemical, and six radiologic parameters. Eight parameters were reported by two or more studies, whereas 13 were reported by a single study. Based on the weight and odds ratio of the predictive parameters, a prognostic scoring system, Emile-Khan Score, was proposed. Several clinical, biochemical, and radiologic predictors of bowel necrosis were reported in the literature. Pooling of odds ratios was feasible for eight factors that were reported by more than one study. Further studies are needed to ascertain the utility of the other predictive factors.Level of evidence: Level II (systematic review and meta-analysis).
Keyphrases
- systematic review
- acute myocardial infarction
- end stage renal disease
- meta analyses
- newly diagnosed
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- randomized controlled trial
- prognostic factors
- risk factors
- heart failure
- case control
- metabolic syndrome
- left ventricular
- cardiovascular events
- cardiovascular disease
- coronary artery disease
- early onset
- weight loss
- adipose tissue
- liver failure
- artificial intelligence
- insulin resistance
- patient reported