影响急性肠系膜缺血患者院内死亡的危险因素分析

Analysis of risk factors affecting in-hospital mortality in patients with acute mesenteric ischemia

目的:探讨影响急性肠系膜缺血(AMI)患者院内死亡的危险因素。方法:回顾性分析2014年1月1日至2022年6月30日在武汉大学人民医院诊断为AMI的67例患者的临床资料,包括基本资料(年龄、性别、既往史和合并症等),实验室检查指标[白细胞计数(WBC)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐、凝血酶原时间(PT)等],以及影像学表现(肠壁积气、肠壁增厚、肠管扩张、腹水)。比较住院期间死亡的AMI患者与生存患者的临床资料,采用二元logistic回归分析AMI患者院内死亡的独立危险因素。统计学方法采用Mann-Whitney U检验和卡方检验。结果:67例AMI患者中,17例死亡,50例生存。死亡与生存AMI患者的年龄、发生器官衰竭患者比例、WBC、ALT、AST、肌酐、PT,以及有肠管扩张、腹水的影像学表现患者比例比较[76岁(68岁,79岁)比61岁(50岁,74岁)、12/17比12.0%(6/50)、15.8×10^(9)/L(13.5×10^(9)/L,23.7×10^(9)/L)比12.1×10^(9)/L(9.1×10^(9)/L,19.4×10^(9)/L)、32.0 U/L(19.0 U/L,88.5 U/L)比20.5 U/L(14.8 U/L,29.0 U/L)、64.0 U/L(33.8 U/L,117.0 U/L)比26.0 U/L(18.5 U/L,36.8 U/L)、135.0μmol/L(61.5μmol/L,198.5μmol/L)比73.5μmol/L(60.5μmol/L,85.0μmol/L)、13.7 s(12.9 s,16.3 s)比12.7 s(11.9 s,13.6 s)、13/17比38.0%(19/50)、10/17比24.0%(12/50)],差异均有统计学意义(Z=3.06,χ^(2)=22.16,Z=2.01、2.69、4.08、2.45、2.78,χ^(2)=7.53、6.98;P=0.002、<0.001、=0.044、=0.007、<0.001、=0.014、=0.006、=0.006、=0.008)。二元logistic回归分析显示,年龄[OR=1.224,95%置信区间1.011~1.482,P=0.038]、器官衰竭(OR=113.989,95%置信区间1.353~9604.644,P=0.036)、腹水(OR=348.289,95%置信区间1.676~72357.934,P=0.032)均是AMI患者院内死亡的独立危险因素。结论:AMI患者年龄大、出现器官衰竭和存在腹水是其住院期间死亡的独立危险因素。

Objective To investigate the risk factors affecting in-hospital mortality in patients with acute mesenteric ischemia(AMI).Methods From January 1,2014 to June 30,2022,the clinical data of 67 patients diagnosed with AMI at Renmin Hospital of Wuhan University were retrospectively analyzed,which included basic data(age,gender,past medical history and comorbidities,etc.),laboratory results(white blood cell count(WBC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,prothrombin time(PT),etc.),and imaging manifestations(intestinal pneumatosis,intestinal wall thickening,intestinal dilation,ascites).The clinical data of AMI patients who died during hospitalization were compared with that of AMI patients who survived.Binary logistic regression was used to analyze the independent risk factors of in-hospital mortality in patients with AMI.Mann-Whitney U test and chi-square test were used for statistical analysis.Results Among the 67 patients with AMI,17 died and 50 survived.There were significant differences between died and survived patients with AMI in age,the proportion of patients with organ failure,WBC,ALT,AST,creatinine,PT,and the proportion of patients with intestinal dilatation and ascites(76 years old(68 years old,79 years old)vs.61 years old(50 years old,74 years old),12/17 vs.12.0%(6/50),15.8×10^(9)/L(13.5×10^(9)/L,23.7×10^(9)/L)vs.12.1×10^(9)/L(9.1×10^(9)/L,19.4×10^(9)/L),32.0 U/L(19.0 U/L,88.5 U/L)vs.20.5 U/L(14.8 U/L,29.0 U/L),64.0 U/L(33.8 U/L,117.0 U/L)vs.26.0 U/L(18.5 U/L,36.8 U/L),135.0μmol/L(61.5μmol/L,198.5μmol/L)vs.73.5μmol/L(60.5μmol/L,85.0μmol/L),13.7 s(12.9 s,16.3 s)vs.12.7 s(11.9 s,13.6 s),13/17 vs.38.0%(19/50),10/17 vs.24.0%(12/50);Z=3.06,χ^(2)=22.16,Z=2.01,2.69,4.08,2.45 and 2.78,χ^(2)=7.53 and 6.98;P=0.002,<0.001,=0.044,=0.007,<0.001,=0.014,=0.006,=0.006 and=0.008).The results of binary logistic regression analysis showed that age(OR=1.224,95%confidence interval 1.011 to 1.482,P=0.038),organ failure(OR=113.989,95%confidence interval 1.353 to 9604.644,P=0.036),and ascites(OR=348.289,95%confidence interval 1.676 to 72357.934,P=0.032)were independent risk factors of in-hospital mortality in AMI patients.Conclusion Age,organ failure and ascites are independent risk factors of in-hospital mortality in AMI patients.