TY - JOUR
T1 - MELD predicts mortality in conservatively managed pneumatosis intestinalis in cirrhotics
AU - Pang, John
AU - Karipineni, Farah
AU - Parsikia, Afshin
AU - Campos, Stalin
AU - Horrow, Mindy M.
AU - Ortiz, Jorge
PY - 2013
Y1 - 2013
N2 - Pneumatosis intestinalis (PI) is a radiologic finding associated with multiple conditions and a high mortality rate (33-40%, 1-3). The current literature addressing PI is limited to an unselected population. This is the first study addressing the management of PI in cirrhotics, a population in which surgical intervention is particularly risky. While nonoperative management is acceptable in the general population, it is unknown whether the same is true when managing patients with underlying cirrhosis. We retrospectively identified cases of PI found on computed tomography (CT) scans performed on cirrhotics from 2004 to 2011. Chart review included comorbidities, hospital course, serum lactate levels, APACHE scores and MELD scores. Nine cirrhotics with PI were identified. Eight were managed conservatively. One patient with MELD score of 18 underwent exploration and died. In total, six patients died. The mean MELD score in patients who died was higher than in those who survived (28 vs. 14). Mortality was 100% in cirrhotic patients with PI whose MELD was greater than 16. Mean lactate levels (33mg/dL vs. 21mg/dL) and mean APACHE scores (28 vs. 15) were also higher in those who died. Serum bicarbonate levels and white blood cell counts were not consistently elevated. Our results suggest that the MELD score is an important predictor of mortality in cirrhotics with PI. Serum lactate and APACHE scores are also important markers. Larger studies are required to determine whether there is a role for operative management in cirrhotic patients with a MELD lower than 16.
AB - Pneumatosis intestinalis (PI) is a radiologic finding associated with multiple conditions and a high mortality rate (33-40%, 1-3). The current literature addressing PI is limited to an unselected population. This is the first study addressing the management of PI in cirrhotics, a population in which surgical intervention is particularly risky. While nonoperative management is acceptable in the general population, it is unknown whether the same is true when managing patients with underlying cirrhosis. We retrospectively identified cases of PI found on computed tomography (CT) scans performed on cirrhotics from 2004 to 2011. Chart review included comorbidities, hospital course, serum lactate levels, APACHE scores and MELD scores. Nine cirrhotics with PI were identified. Eight were managed conservatively. One patient with MELD score of 18 underwent exploration and died. In total, six patients died. The mean MELD score in patients who died was higher than in those who survived (28 vs. 14). Mortality was 100% in cirrhotic patients with PI whose MELD was greater than 16. Mean lactate levels (33mg/dL vs. 21mg/dL) and mean APACHE scores (28 vs. 15) were also higher in those who died. Serum bicarbonate levels and white blood cell counts were not consistently elevated. Our results suggest that the MELD score is an important predictor of mortality in cirrhotics with PI. Serum lactate and APACHE scores are also important markers. Larger studies are required to determine whether there is a role for operative management in cirrhotic patients with a MELD lower than 16.
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U2 - 10.1016/j.ijsu.2013.08.012
DO - 10.1016/j.ijsu.2013.08.012
M3 - Article
C2 - 23994000
AN - SCOPUS:84887135569
SN - 1743-9191
VL - 11
SP - 816
EP - 818
JO - International Journal of Surgery
JF - International Journal of Surgery
IS - 9
ER -