Universität zu Köln

Della Seta, Marta, Kloeckner, Roman, dos Santos, Daniel Pinto, Walter-Rittel, Thula Cannon, Hahn, Felix, Henze, Jorn, Gropp, Annika, Pratschke, Johann, Hamm, Bernd, Geisel, Dominik and Auer, Timo Alexander (2021). Pneumatosis intestinalis and porto-mesenteric venous gas: a multicenter study. BMC Med. Imag., 21 (1). LONDON: BMC. ISSN 1471-2342

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Abstract

Background Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine. Methods A total of 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis). Results Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p < 0.001). In the entire patient group, 53.5% (155/290) were treated surgically with a 90d mortality of 58.8% (91/155) in this latter group, while 90d mortality was 51.1% (69/135) in patients treated conservatively. In the patients who survived > 90d treated conservatively (24.9% of the entire collective; 72/290) PMVG/PI was defined as benign/reversible. PMVG, COPD, sepsis and a low platelet count were found to correlate with a worse prognosis helping to identify patients who might not profit from surgery, in this context our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV. Conclusion Although PI is associated with high morbidity and mortality, benign causes are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Della Seta, Marta UNSPECIFIED UNSPECIFIED UNSPECIFIED Kloeckner, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED dos Santos, Daniel Pinto UNSPECIFIED UNSPECIFIED UNSPECIFIED Walter-Rittel, Thula Cannon UNSPECIFIED UNSPECIFIED UNSPECIFIED Hahn, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Henze, Jorn UNSPECIFIED UNSPECIFIED UNSPECIFIED Gropp, Annika UNSPECIFIED UNSPECIFIED UNSPECIFIED Pratschke, Johann UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamm, Bernd UNSPECIFIED UNSPECIFIED UNSPECIFIED Geisel, Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Auer, Timo Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-588344
DOI:	10.1186/s12880-021-00651-y
Journal or Publication Title:	BMC Med. Imag.
Volume:	21
Number:	1
Date:	2021
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1471-2342
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CYSTOIDES-INTESTINALIS; CLINICAL-SIGNIFICANCE; PREDICTIVE EVALUATION; BENIGN PNEUMATOSIS; SURGERY; ASSOCIATION; TOMOGRAPHY Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58834