Prognostic Value of the HCO3-to-Lactate Ratio in Acute Mesenteric Ischemia: A Retrospective Analysis

IF 1.4 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Annals of vascular surgery Pub Date : 2025-04-14 DOI:10.1016/j.avsg.2025.03.026

Andreia Pinelo , Luís Loureiro , Marco Pires , Daniel Mendes , Henrique Almeida , Miguel Queirós , João Cabral , Samuel Cardoso , Rui Machado

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引用次数: 0

Abstract

Background

Acute mesenteric ischemia (AMI) is a life-threatening emergency with persistently high mortality rates, requiring improved tools for perioperative risk assessment. This study investigates the real-world outcomes of patients with occlusive arterial AMI undergoing surgery, focusing on predictors of short-term mortality.

Methods

A retrospective, single-center analysis was conducted on patients undergoing emergent mesenteric surgery for occlusive arterial AMI between January 2015 and May 2024. The primary outcome was 30-day survival; secondary outcomes included predictors of in-hospital mortality based on preoperative laboratory parameters.

Results

Sixty patients (mean age 75 ± 12 years) were included, with a 30-day survival rate of 45%. Of the 60 patients, 15 (75%) with acute-on-chronic symptoms (n = 20) survived, compared to 12 (30%) with acute onset (n = 40) (P = 0.003). Multivariate Cox regression identified lactate, bicarbonate (HCO₃), the HCO₃-to-lactate ratio, and neutrophil count as predictors of 30-day mortality. The HCO₃-to-lactate ratio ≤10 demonstrated high predictive accuracy (area under the curve 0.832, sensitivity 90.6%, specificity 75%). In acute-onset cases, excluding acute-on-chronic symptoms improved specificity to 100%.

Conclusion

The HCO₃-to-lactate ratio is a robust prognostic marker in occlusive arterial AMI, reflecting both tissue hypoperfusion and impaired metabolic compensation. These findings support its potential utility in risk stratification and in guiding clinical decision-making in the emergent management of AMI.

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hco3 -乳酸比值在急性肠系膜缺血中的预后价值：回顾性分析

背景急性肠系膜缺血（AMI）是一种危及生命的急症，死亡率居高不下，需要改进围手术期风险评估工具。本研究调查了动脉闭塞性AMI手术患者的实际预后，重点关注短期死亡率的预测因素。方法回顾性、单中心分析2015年1月至2024年5月接受急诊肠系膜手术治疗动脉闭塞性AMI的患者。主要终点为30天生存率；次要结局包括基于术前实验室参数的院内死亡率预测因子。结果纳入60例患者，平均年龄75±12岁，30天生存率为45%。在60例患者中，15例（75%）有急性慢性症状（n = 20）存活，而12例（30%）有急性发作（n = 40）（P = 0.003）。多变量Cox回归发现乳酸、碳酸氢盐（HCO3）、HCO3与乳酸的比值和中性粒细胞计数是30天死亡率的预测因子。hco3与乳酸比值≤10预测准确率高（曲线下面积0.832，灵敏度90.6%，特异性75%）。在急性发病病例中，排除慢性急性症状可将特异性提高到100%。结论hco3 -乳酸比值是动脉闭塞性AMI的一个可靠的预后指标，反映了组织灌注不足和代谢代偿受损。这些发现支持了它在急性心肌梗死紧急管理的风险分层和指导临床决策方面的潜在效用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence