• Marc Leone, Carole Bechis, Karine Baumstarck, Alexandre Ouattara, Olivier Collange, Pascal Augustin, Djillali Annane, Charlotte Arbelot, Karim Asehnoune, Olivier Baldési, Simon Bourcier, Laurence Delapierre, Didier Demory, Baptiste Hengy, Carole Ichai, Eric Kipnis, Etienne Brasdefer, Sigismond Lasocki, Matthieu Legrand, Olivier Mimoz, Thomas Rimmelé, Jugurtha Aliane, Pierre-Marie Bertrand, Nicolas Bruder, Fanny Klasen, Emilie Friou, Bruno Lévy, Oriane Martinez, Eric Peytel, Alexandra Piton, Elisa Richter, Kamel Toufik, Marie-Charlotte Vogler, Florent Wallet, Mourad Boufi, Bernard Allaouchiche, Jean-Michel Constantin, Claude Martin, Samir Jaber, and Jean-Yves Lefrant.
• Service d'anesthésie et de réanimation, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France, marc.leone@ap-hm.fr.
• Intensive Care Med. 2015 Apr 1;41(4):667-76.

BackgroundIn the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI.MethodsA retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes.ResultsThe death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4.ConclusionAcute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.

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