Objective: Acute mesenteric vein thrombosis (AMVT) is one of the acute abdominal diseases with onset, rapid progression, extensive intestinal necrosis, and requiring immediate surgical resection. The purpose of this study was to determine the risk factors of nosocomial intestinal resection in patients with AMVT.
Methods: We retrospectively analyzed 64 patients with AMVT diagnosed by CTA in Affiliated Hospital of Kunming University of Science and Technology from January 2013 to December 2021. We compared patients who underwent intestinal resection (42 cases) with those who did not undergo intestinal resection (22 cases). The area under the ROC curve was evaluated and the forest map was drawn.
Results: Among the 64 patients, 6 cases (9.38%) had a fever, 60 cases (93.75%) had abdominal pain, 9 cases (14.06%) had a history of diabetes, 8 cases (12.5%) had a history of deep vein thrombosis (DVT), and 25 cases (39.06%) had ascites suggested by B ultrasound or CT after admission. The mean age of all patients was (49.86±16.25) years. The mean age of patients in the enterectomy group was (47.71±16.20) years. The mean age of patients in the conservative treatment group (without enterectomy) was (53.95±15.90) years. In univariate analysis, there were statistically significant differences in leukocyte count (P=0.003), neutrophil count (P=0.001), AST(P=0.048), total bilirubin (P=0.047), fibrinogen (P= 0.022) and DD2 (P= 0.024) between the two groups. Multivariate logistic regression analysis showed that admission white blood cell count (OR=1.153, 95%CI: 1.039-1.280P =0.007) was an independent risk factor for intestinal resection in patients with AMVT. ROC curve showed that white blood cell count (AUC=0.759 95%CI: 0.620-0.897P =0.001 optimal threshold :7.815 sensitivity: 0.881 specificity: 0.636) had a good predictive value for emergency enterectomy for AMVT.
Conclusions: Among patients with AMVT, patients with a higher white blood cell count at admission were more likely to have intestinal necrosis and require emergency enterectomy. This study is helpful for clinicians to accurately determine whether emergency intestinal resection is needed in patients with AMVT after admission, prevent further intestinal necrosis, and improve the prognosis of patients.