Predictors of Mortality in Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis

Introduction: To highlight predictors of mortality in acute mesenteric ischemia (AMI) by conducting a meta-analysis of all relevant published studies.

Methods: PubMed, Cochrane, and Google Scholar were searched from their inception till October 31, 2021. Studies evaluating predictors of mortality were selected. Only those factors were selected for meta-analysis that was reported by at least four studies. Meta-analysis was performed on selected factors using the random-effects model by using Revman 5.3 software.

Results: Fifty-one studies were included evaluating 10,425 patients of AMI. Studies selected had a low risk of bias (Median = 7). Thirty-three factors were evaluated in our review. Age (OR 1.17, 95% CI 1.08-1.27), chronic renal disease (OR 2.47, 95% CI 1.37-4.45), patient dependency (OR 3.01, 95% CI 1.95-4.65), arrhythmias (OR 1.93, 95% CI 1.38-2.69), cardiac failure (OR 2.28, 95% CI 1.57-3.31), hypotension (OR 3.44, 95% CI 1.81-6.54), large bowel involvement (OR 2.98, 95% CI 1.44-6.17), small and large bowel involvement (OR 1.86, 95% CI 1.23-2.81), creatinine (OR 1.67, 95% CI 1.27-2.20), lactate (OR 1.43, 95% CI 1.26-1.62), delay to surgery (OR 2.51, 95% CI 1.58-3.99) and inotropes (OR 3.79, 95% CI 1.47-9.77) were significantly associated with mortality. On the contrary bowel wall thickening (OR 0.53, 95% CI 0.38-0.88), anticoagulation (OR 0.27, 95% CI 0.10-0.74), and revascularization (OR 0.30, 95% CI 0.13-0.69) were significantly associated with survival.

Conclusions: In conclusion, Age, chronic renal disease, diabetes, patient dependency, arrhythmias, cardiac failure, hypotension, large bowel involvement, small & large bowel involvement, creatinine, lactate, delay to surgery, and inotropes were significantly associated with mortality while anticoagulants, revascularization and bowel thickening on CT was associated with decreased mortality.