Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia

Shuh-Kuan Liau; George Kuo; Chao-Yu Chen; Yueh-An Lu; Yu-Jr Lin; Cheng-Chia Lee; Cheng-Chieh Hung; Ya-Chung Tian; Hsiang-Hao Hsu

doi:10.4240/wjgs.v14.i8.809

Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia

World J Gastrointest Surg. 2022 Aug 27;14(8):809-820. doi: 10.4240/wjgs.v14.i8.809.

Authors

Shuh-Kuan Liau¹, George Kuo¹, Chao-Yu Chen¹, Yueh-An Lu¹, Yu-Jr Lin², Cheng-Chia Lee¹, Cheng-Chieh Hung¹, Ya-Chung Tian¹, Hsiang-Hao Hsu³

Affiliations

¹ Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
² Research Services Center for Health Information, Chang Gung University, Taoyuan 333, Taiwan.
³ Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan. hsianghao@gmail.com.

Abstract

Background: Mesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However, reports on prognostic factors in this population are limited.

Aim: To elucidate the in-hospital outcomes of acute mesenteric ischemia in chronic dialysis patients and to analyze protective factors for survival.

Methods: The case data of 426 chronic dialysis patients who were hospitalized in a tertiary medical center for acute mesenteric ischemia over a 14-year period were retrospectively reviewed. Of these cases, 103 were surgically confirmed, and the patients were enrolled in this study. A Cox regression analysis was used to evaluate the protective factors for survival.

Results: The in-hospital mortality rate among the 103 enrolled patients was 46.6%. Univariate analysis was performed to compare factors in survivors and nonsurvivors, with better in-hospital outcomes associated with a surgery delay (defined as the time from onset of signs and symptoms to operation) < 4.5 d, no shock, a higher potassium level on day 1 of hospitalization, no resection of the colon, and a total bowel resection length < 110 cm. After 1 wk of hospitalization, patients with lower white blood cell count and neutrophil counts, higher lymphocyte counts, and lower C-reactive protein levels had better in-hospital outcomes. Following multivariate adjustment, a higher potassium level on day 1 of hospitalization (HR 1.71, 95%CI 1.19 to 2.46; P = 0.004), a lower neutrophil count (HR 0.91, 95%CI 0.84 to 0.99; P = 0.037) at 1 wk after admission, resection not involving the colon (HR 2.70, 95%CI 1.05 to 7.14; P = 0.039), and a total bowel resection length < 110 cm (HR 4.55, 95%CI 1.43 to 14.29; P = 0.010) were significantly associated with survival.

Conclusion: A surgery delay < 4.5 d, no shock, no resection of the colon, and a total bowel resection length < 110 cm predicted better outcomes in chronic dialysis patients with acute mesenteric ischemia.

Keywords: Chronic dialysis; End-stage kidney disease; Mesenteric ischemia; Protective factors; Surgery; Survival.