The prospective multicenter observational study of acute mesenteric ischemia (AMeSI): the results of the Arkhangelsk center

Abstract

The objective was to assess the disease rate, prevalence of risk factors, diagnostic and management methods as well as outcomes in patients with acute mesenteric ischemia (AMI).Materials and methods. During 10 months in 2022-2023, the study included all patients with probable or confirmed diagnosis of AMI, in whom we recorded the presence of known risk factors, clinical and laboratory manifestations of AMI, methods of its diagnosis, management and outcomes within one year.Results. Totally, 705 patients from 32 centers were included in the work, among whom 418 patients were diagnosed with AMI. In Arkhangelsk, 39 patients (mean age – 73 years) were included into the study. According to results of the center in Arkhangelsk, the diagnosis of AMI was confirmed in 69% of patients, while the incidence among all hospitalized was 0.13%. None of the known risk factors (smoking, atrial fibrillation, atherosclerosis, arterial hypertension, previous myocardial infarction and thromboembolic complications) demonstrated a significant statistical association with the development of AMI. Among clinical manifestations, patients with confirmed AMI more likely developed signs of shock compared to patients with unconfirmed AMI (p = 0.028). Laboratory parameters did not differ significantly in both groups; however, in AMI non-survivors, we observed higher blood lactate concentrations. In most cases with confirmed AMI, the diagnosis was established during surgery. In 72% of cases, the situation was assessed as incurable; in 24% of patients, intestinal resection was performed. Mortality in patients with confirmed AMI was 78%.Conclusion. The lack of clear predictors of the disease, specific clinical signs of AMI and available laboratory tests often leads to delay in diagnosis and appropriate management, which causes significant mortality. Further analysis of the data is necessary to improve diagnosis and the results of treatment of the patients with AMI.