Incidence of contrast-induced acute kidney injury in patients with acute mesenteric ischemia and identification of potential predictive factors.

OBJECTIVE: Contrast-enhanced computed tomography angiography (CTA) is commonly used to investigate acute abdominal conditions, but the risk of contrast-induced acute kidney injury (CI-AKI) has been poorly investigated in patients with acute mesenteric ischemia. The aim of the present study was to evaluate the incidence of CI-AKI in these patients and identify potential predictive factors. METHODS: Patients admitted for acute mesenteric ischemia who had a diagnostic CTA with contrast medium and a follow-up of creatinine concentration were retrospectively included. RESULTS: Among 53 patients included, 9 (16.9%) developed CI-AKI. The prevalence of chronic kidney disease did not differ significantly between those who developed CI-AKI and those who did not (33.3 vs 18.2%, p=.372). Plasma total bilirubin and conjugated bilirubin levels were significantly higher in patients who developed CI-AKI (17.5 vs 8.0 µmol/L, p=.013 and 8.0 vs 3.0 µmol/L, p=.031, respectively). The proportion of patients who had revascularization was similar between patients who developed CI-AKI and those who did not (11.1 vs 20.5%, p>.999). No significant difference was observed for 30-day mortality and all-cause mortality for a median follow-up of 168 days (22.2 vs 13.6%, p=.611; and 33.3 vs 61.4%, p=.153, respectively). CONCLUSION: This study reports the incidence of CI-AKI in patients with acute mesenteric ischemia after diagnostic CTA with contrast medium. Plasma bilirubin levels were a predictive factor of CI-AKI in these patients. The administration of contrast media during revascularization was not associated with an increased risk of CI-AKI.

Automatic Measurement of Maximal Diameter of Abdominal Aortic Aneurysm on Computed Tomography Angiography Using Artificial Intelligence.

INTRODUCTION: The treatment of abdominal aortic aneurysm relies on surgical repair and the indication mainly depends on its size evaluated by the maximal diameter (Dmax). The aim of this study was to evaluate a new automatic method based on artificial intelligence to measure the Dmax on computed tomography angiography. METHODS: A fully automatic segmentation of the vascular system was performed using a hybrid method combining expert system with supervised deep learning. The aorta centreline was extracted from the segmented aorta and the aortic diameters were automatically calculated. Results were compared to manual segmentation performed by two human operators. RESULTS: The median absolute error between the two human operators was 1.2 mm (IQR 0.5-1.9). The automatic method using the deep learning algorithm demonstrated correlation with the human segmentation, with a median absolute error of 0.8 (0.5-4.2) mm and a coefficient correlation of 0.91 (P < 0.001). CONCLUSIONS: Although validation in larger cohorts is required, this method brings perspectives to develop new tools to standardize and automate the measurement of abdominal aortic aneurysm Dmax in order to help clinicians in the decision-making process.

Vascular Calcifications are Associated with Increased Mortality in Patients with Acute Mesenteric Ischemia.

BACKGROUND: Vascular calcifications have been identified as predictors of mortality in several cardiovascular diseases but have not been investigated in context of acute mesenteric ischemia. The aim of this study was to investigate the impact of vascular calcifications in patients with acute mesenteric ischemia. METHODS: Patients admitted for an acute mesenteric ischemia were retrospectively included. The presence of calcifications in the visceral aorta, the celiac trunk, the superior mesenteric artery, and the renal arteries was assessed on computed tomography scan images at the arterial phase. The calcification volumes were measured using the software Aquarius iNtuition Edition®. RESULTS: The all-cause mortality was 55 out of 86 patients (63.9%) for a median follow-up of 3.5 days (1-243). The survival rate of patients with calcification in the superior mesenteric artery was significantly lower than that of those without calcification (22% vs. 55.6%, P = 0.019). Patients who died had significantly a higher frequency of calcifications in the superior mesenteric artery, the visceral aorta, the celiac trunk, and the renal arteries. CONCLUSIONS: The presence of vascular calcifications in the superior mesenteric artery is associated with increased mortality in patients diagnosed with acute mesenteric ischemia. Further studies are required to identify the mechanisms underlying this association.

Evaluation of the Impact of Sarcopenia in Patients with Acute Mesenteric Ischemia.

BACKGROUND: Sarcopenia has been identified as a prognostic factor in several diseases. The aim of this study was to investigate the impact of sarcopenia in patients with acute mesenteric ischemia. METHODS: Consecutive patients admitted for acute mesenteric ischemia were retrospectively included at the University Hospital of Nice. Sarcopenia was assessed by the measurement of total psoas area normalized for height (TPA/H) on CT-scan and was defined as a TPA/H inferior to the lowest sex-specific quartile. The management of the patients and the 30-day outcomes were compared between sarcopenic and nonsarcopenic patients. Correlations between the TPA/H and biological characteristics were investigated. RESULTS: Among the 80 patients included, the lowest quartile of TPA/H that defined sarcopenia was 406.1 mm2/m2 for men and 307 mm2/m2 for women. The rate of revascularization or the need of intestinal resection did not significantly differ between sarcopenic and nonsarcopenic patients (10.5% vs. 26.2%, P = 0.214 and 26.3% vs. 47.5%, P = 0.118 respectively). The 30-day mortality did not significantly differ between the two groups (63.2% vs. 47.5%, P = 0.297). The TPA/H was significantly negatively correlated with the neutrophil, thrombocyte, and monocyte counts (r = -0.283; -0.288, -0.225, P < 0.05) and positively correlated with the hemoglobin concentration and the glomerular filtration rate (r = 0.368; 0.261, P < 0.05). CONCLUSIONS: Further studies on longer follow-up period would be of interest to fully understand the prognostic value of sarcopenia in patients with acute mesenteric ischemia.

Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia.

INTRODUCTION: Acute mesenteric ischemia is associated with high rates of mortality. The aim of this study was to investigate the prognostic value of the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) on 30-day outcomes in patients with acute mesenteric ischemia. MATERIAL AND METHODS: Consecutive patients who were admitted for an acute mesenteric ischemia were retrospectively included. The full white blood count at the time of admission to the hospital was recorded. The population was divided into 4 subgroups according to the quartiles of the NLR and the PLR. The 30-day outcomes including the mortality and the complications were compared among the subgroups. RESULTS: In total, 106 patients were included. A surgical treatment including revascularization and/or digestive resection was performed for 56 patients (52.8%). The 30-day all-cause mortality was 72 patients (67.9%). Patients with higher PLR value (PLR >429.3) had significantly higher rate of mortality compared to the other groups (80.8% vs 46.2%, 66.7% and 77.8%, p = 0.03). No significant difference on 30-day outcome was observed among the subgroups divided according to the NLR. CONCLUSION: The PLR, but not the NLR, is a predictive factor of 30-day mortality in patients with acute mesenteric ischemia.