Liau SK, Kuo G, Chen CY, Lu YA, Lin YJ, Lee CC, Hung CC, Tian YC, Hsu HH. Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia. World J Gastrointest Surg 2022; 14(8): 809-820 [PMID: 36157361 DOI: 10.4240/wjgs.v14.i8.809]
Corresponding Author of This Article
Hsiang-Hao Hsu, MD, PhD, Doctor, Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, No. 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. hsianghao@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shuh-Kuan Liau, George Kuo, Chao-Yu Chen, Yueh-An Lu, Cheng-Chia Lee, Cheng-Chieh Hung, Ya-Chung Tian, Hsiang-Hao Hsu, Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Yu-Jr Lin, Research Services Center for Health Information, Chang Gung University, Taoyuan 333, Taiwan
Author contributions: Hsu HH is the guarantor of the integrity of the entire study, designed the study, defined the intellectual content, participated in the literature search, and reviewed the manuscript; Liau SK performed the research, wrote the first draft, and analyzed the data; Lin YJ analyzed the data; Kuo G, Chen CY, Lu YA, Lee CC, Hung CC, and Tian YC participated in the literature search and reviewed the manuscript. All authors read and approved the final manuscript.
Supported byLinkou Chang Gung Memorial Hospital, No. CMRPG1K0141 and CMRPG1J0033.
Institutional review board statement: The study was reviewed and approved for publication by our institutional reviewer.
Informed consent statement: This retrospective study was conducted at a tertiary referral center that has 3700 beds and conducts an annual average of 107000 inpatient services in northern Taiwan. This study was approved by the Institutional Review Board (IRB) of the study hospital. The need for informed consent was waived because of the study’s retrospective and noninterventional design, and patient confidentiality was maintained.
Conflict-of-interest statement: The authors report no conflicts of interest in this work.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author: hsianghao@gmail.com.
STROBE statement: The authors have read the STROBE statement-checklist of items, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Corresponding author: Hsiang-Hao Hsu, MD, PhD, Doctor, Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, No. 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. hsianghao@gmail.com
Received: April 19, 2022 Peer-review started: April 19, 2022 First decision: June 10, 2022 Revised: July 2, 2022 Accepted: July 20, 2022 Article in press: July 20, 2022 Published online: August 27, 2022 Processing time: 127 Days and 2.6 Hours
ARTICLE HIGHLIGHTS
Research 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.
Research motivation
Reports on prognostic factors in chronic dialysis patients with acute mesenteric ischemia are lacking.
Research objectives
The aim of this retrospective study was to identify the protective factors for mesenteric ischemia in chronic dialysis patients to promote earlier initiation of aggressive therapy in this targeted population and improve their poor prognosis.
Research methods
One hundred and three chronic dialysis patients with surgically confirmed acute mesenteric ischemia in a tertiary medical center over 14 years were retrospectively analyzed. Cox regression and Kaplan-Meier analysis were used for prognostic analysis by R statistical analysis software.
Research 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, no resection of the colon, and a total bowel resection length < 110 cm. Following multivariate adjustment, 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.
Research conclusions
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.
Research perspectives
This study emphasizes that early diagnosis and prompt surgical intervention in chronic dialysis patients with acute mesenteric ischemia are beneficial.
