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Risk Factors for Acute Mesenteric Ischemia in Critically Ill Burns Patients—A Matched Case–Control Study

Soussi, Sabri*; Taccori, Marina*; De Tymowski, Christian*; Depret, François*,¶,**; Chaussard, Maïté*; Fratani, Alexandre*; Jully, Marion*; Cupaciu, Alexandru*; Ferry, Axelle*; Benyamina, Mourad*; Serror, Kevin; Boccara, David; Chaouat, Marc; Mimoun, Maurice; Cattan, Pierre; Zagdanski, Anne-Marie§; Anstey, James||; Mebazaa, Alexandre*,¶,**; Legrand, Matthieu*,¶,** for the PRONOBURN group

doi: 10.1097/SHK.0000000000001140
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Objective: Burn-induced shock can lead to tissue hypoperfusion, including the gut. We performed this study to describe burn patients at risk of acute mesenteric ischemia (AMI) with the aim to identify potential modifiable risk factors.

Methods: Retrospective case–control study including adult severely burned patients between August 2012 and March 2017. Patients who developed AMI were matched to severely burned patients without AMI at a ratio of 1:3 (same year of admission, Abbreviated Burn Severity Index [ABSI], and Simplified Acute Physiology Score II [SAPSII]). Univariate and multiple regression analyses were performed.

Results: Of 282 severely burned patients, 15 (5%) were diagnosed with AMI. In the AMI group, patients had a median (interquartile range) total body surface area (TBSA), SAPSII, and ABSI of 55 (25–63)%, 53 (39–70), and 11 (8–13), respectively. The AMI mechanism in all patients was nonocclusive. Decreased cardiac index within the first 24 h (H24 CI), higher sequential organ failure assessment score on day 1 (D1 SOFA), and hydroxocobalamin use were associated with AMI. Odds ratios were 0.18 (95% confidence interval [CI], 0.03–0.94), 1.6 (95% CI, 1.2–2.1), and 4.6 (95% CI, 1.3–15.9), respectively, after matching. Multiple regression analysis showed that only decreased H24 CI and higher D1 SOFA were independently associated with AMI. Ninety-day mortality was higher in the AMI group (93% vs. 46% [P = 0.001]).

Conclusions: Burns patients with initial low cardiac output and early multiple organ dysfunction are at high risk of nonocclusive AMI.

*AP-HP, Hôpital Saint-Louis, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France

AP-HP, Hôpital Saint-Louis, Plastic Surgery and Burn Unit, Paris, France

AP-HP, Hôpital Saint-Louis, Department of Digestive Surgery, Paris, France

§AP-HP, Hôpital Saint-Louis, Department of Radiology, Paris, France

||Intensive Care Unit, Royal Melbourne Hospital, Parkville, Melbourne, Australia

Hôpital Lariboisière, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France

**Université Paris Diderot, Paris, France

Address reprint requests to Sabri Soussi, MD, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France. E-mail: sabri.soussi@aphp.fr

Received 20 December, 2017

Revised 23 January, 2018

Accepted 15 March, 2018

This study was partially supported by a grant from “la fondation des gueules cassées,” a nonprofit organization.

The authors report no conflicts of interest.

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© 2019 by the Shock Society