Clinical Characteristics Of Acute Mesenteric Ischemia And The Predictive Value Of NLR And ALB On Its Prognosis

Background and ObjectiveAcute mesenteric ischemia(AMI)is a ischemic bowel disease caused by acute limitation of blood flow in the intestine due to various causes.Common causes of ischemia include mesenteric embolism,thrombosis,vasospasm,or underperfusion.With the aging of the population,the incidence of vascular diseases increases,and the incidence of the disease also shows an increasing trend,but its clinical manifestations are not specific,leading to a high rate of misdiagnosis,and rapid disease progression leads to poor prognosis,the mortality can be as high as 50-70%without timely intervention.Neutrophil-to-lymphocyte ratio(NLR)is a commonly used indicator to reflect the inflammatory state of the body in recent years,which is believed to assist in the diagnosis of AMI,and many studies have shown that NLR elevation is a predictor of poor prognosis in ischemic disease.Albumin(ALB)has a variety of important physiological functions.ALB levels have been shown to be associated with the severity of the disease in hospitalized patients,and ALB has been found to be a protective factor for the prognosis of patients with ischemic bowel disease.However,there are few studies on the prognosis of AMI by NLR and ALB.In this study,clinical data of AMI patients were retrospectively analyzed.The main purpose was to analyze and summarize the clinical characteristics of AMI,and to explore the predictive value of NLR and ALB levels on the prognosis of AMI,so as to provide more basis for the diagnosis,treatment and prognosis judgment of AMI.MethodsWe collected a total of 192 AMI patients admitted to the first affiliated hospital of zhengzhou university from April 2013 to December 2019,and recorded baseline data,signs and symptoms,laboratory and imaging examinations,treatment and prognosis of all enrolled patients,and conducted a retrospective study on their clinical characteristics.Taking in-hospital death as the end event,they were divided into survival group and death group.SPSS23.0 and MedCalc software were used for data analysis and chart making.The counting data is expressed in frequency(percentage).T test or mann-whitney U test were used to compare the measurement data between groups.The enumeration data were compared between groups using the chi-square test or fisher's exact test.As for the correlation study of NLR and ALB on the prognosis of AMI,the risk factors that may be related to the prognosis,such as age,gender,previous medical history,NLR,ALB and other laboratory indicators,were firstly screened by single factor analysis.Then,multivariate Logistic regression analysis was used to correct for the influence of other factors to obtain independent factors related to the prognosis of AMI.The results were expressed by odds ratio(OR)and 95%confidence interval(CI).ROC curve was drawn and the predictive value of NLR,ALB and other indicators to the prognosis was analyzed by comparing the area under the curve.P<0.05 was considered statistically significant.Results1.192 patients with AMI included 101 males and 91 females,with a male to female ratio of 1.11:1.122(63.5%)patients aged 60 years or above.2.89.6%of the patients were combined with one or more underlying diseases,including 62 cases of hypertension(32.3%),50 cases of atrial fibrillation(26.04%),49 cases of coronary heart disease(25.5%),and others such as cerebral infarction,hyperlipidemia and diabetes.3.The main clinical manifestations were abdominal pain in 187 cases(97.4%),abdominal distension in 83 cases(39.0%),nausea in 79 cases(41.1%),vomiting in 65 cases(33.9%),hematochezia in 59 cases(30.7%),others included diarrhea,weight loss,and cessation of exhaust and defecation.Abdominal pain was dominant in the upper abdomen and periumbilicus,respectively.Signs of peritonitis were found in 24.0%of the patients.Fifty-six cases were misdiagnosed,with a misdiagnosis rate of 29.2%.4.Laboratory examination:without specificity,The decrease in ALB was 58.9%.The calculated NLR is 7.25[3.57,17.1].5.Auxiliary examination:the positive rates of vascular ultrasound,CT,CTA and angiography were 47.7%,82.1%,90.8%and 100%.CT findings of ascites,peritoneal free gas and intestinal wall gas were higher in the death group than in the survival group(P<0.05).6.40.1%of the patients received medical treatment,45.3%of the patients received subcutaneous interventional therapy,and 19.3%of the patients underwent surgical treatment.There were 36 cases of death,with a mortality rate of 18.8%,The main causes of death were multiple organ failure and septic shock.7.The level of NLR in the death group was higher than that in the survival group,and the level of ALB was lower than that in the survival group,the differences were statistically significant(P<0.001),and there were differences between the death group and the survival group in atrial fibrillation,cerebral infarction,coronary heart disease,shock,peritonitis,age,WBC,APTT,and d-dimer(P<0.05).Multivariate Logistic regression analysis suggested that NLR was an independent risk factor for AMI death(OR=1.064;95%CI:1.028?1.101;P<0.001),ALB was an independent protective factor for AMI death(OR=0.743;95%CI:0.639?0.863;P<0.001),in addition,peritonitis,shock,and WBC were independent risk factors for AMI death.8.The AUC of ALB for predicting AMI death is 0.864,the best cutoff is 29g/L,the sensitivity is 80.6%,and the specificity is 77.6%.The AUC of NLR predicting AMI death was 0.855,the best cutoff was 10.33,the sensitivity was 86.1%,and the specificity was 70.5%.Conclusions1.Acute mesenteric ischemia is common in the elderly with basic diseases,often accompanied by hypertension,coronary heart disease,atrial fibrillation,etc.The clinical manifestations are abdominal pain accompanied by nausea,vomiting,hematochezia,abdominal distension,etc.2.CTA or DSA inspection is preferred when AMI is highly suspected.When CT finds ascites,intestinal wall gas and abdominal free gas,the occurrence of adverse prognosis of AMI should be guarded.3.NLR is an independent risk factor for AMI death,and ALB is an independent protective factor for AMI death.In addition,peritonitis,shock,and WBC are independent risk factors for AMI death.4.NLR and ALB are highly effective in predicting the prognosis of AMI and are expected to be simple and easy to obtain reliable indicators for predicting the prognosis of AMI,which should be paid more attention in clinical practice.