Biological scoring system for early ...
Type de document :
Article dans une revue scientifique
PMID :
URL permanente :
Titre :
Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score.
Auteur(s) :
Zogheib, Elie [Auteur]
Cosse, Cyril [Auteur]
Sabbagh, Charles [Auteur]
Simplification des soins chez les patients complexes - UR UPJV 7518 [SSPC]
Marx, Simon [Auteur]
Caus, Thierry [Auteur]
Henry, Marc [Auteur]
Nader, Joseph [Auteur]
Fumery, Mathurin [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Bernasinski, Michael [Auteur]
Besserve, Patricia [Auteur]
Trojette, Faouzi [Auteur]
Renard, Cedric [Auteur]
Duhaut, Pierre [Auteur]
Kamel, Said [Auteur]
Regimbeau, Jean-Marc [Auteur]
Simplification des soins chez les patients complexes - UR UPJV 7518 [SSPC]
Dupont, Herve [Auteur]
Simplification des soins chez les patients complexes - UR UPJV 7518 [SSPC]
Cosse, Cyril [Auteur]
Sabbagh, Charles [Auteur]
Simplification des soins chez les patients complexes - UR UPJV 7518 [SSPC]
Marx, Simon [Auteur]
Caus, Thierry [Auteur]
Henry, Marc [Auteur]
Nader, Joseph [Auteur]
Fumery, Mathurin [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Bernasinski, Michael [Auteur]
Besserve, Patricia [Auteur]
Trojette, Faouzi [Auteur]
Renard, Cedric [Auteur]
Duhaut, Pierre [Auteur]
Kamel, Said [Auteur]
Regimbeau, Jean-Marc [Auteur]
Simplification des soins chez les patients complexes - UR UPJV 7518 [SSPC]
Dupont, Herve [Auteur]
Simplification des soins chez les patients complexes - UR UPJV 7518 [SSPC]
Titre de la revue :
Annals of Intensive Care
Nom court de la revue :
Ann. Intensive Care
Numéro :
8
Pagination :
46
Date de publication :
2018-04-18
Mot(s)-clé(s) :
Procalcitonin
Scoring system
Bowel ischemia
Cardiac surgery
Scoring system
Bowel ischemia
Cardiac surgery
Discipline(s) HAL :
Sciences du Vivant [q-bio]
Résumé en anglais : [en]
Background
Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. Main issue for physicians ...
Lire la suite >Background Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. Main issue for physicians regarding bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management, resulting in a poorer prognosis, especially after cardiac surgery. The aim of the present series was to propose a simple scoring system based on biological data for the diagnosis of bowel ischemia. Methods In a retrospective monocentric study, patients admitted in cardiac ICU, after cardiovascular surgery, were screened for inclusion. According to a 1:2 ratio (case–control), matching between two groups was based on sex, type of cardiovascular surgery, and the operative period (per month). Patients were divided into two groups: “ischemic group” which corresponds to patients with confirmed bowel ischemia and “non-ischemic group” which corresponds to patients without bowel ischemia. Primary objective was the conception of a scoring system for the diagnosis of bowel ischemia. Secondary objectives were to detail the postoperative morbidity and the diagnostic features for the distinction between acute mesenteric ischemia and ischemic colitis. Results Forty-eight patients (1.3%) had confirmed bowel ischemia (“ischemic group”). According to the 2:1 matching, 96 patients were included in the “non-ischemic group.” Aspartate aminotransferase > 449 UI/L, lactate > 4 mmol/L, procalcitonin > 4.7 μg/L, and myoglobin > 1882 μg/L were found to be independently associated with bowel ischemia. Based on their respective odds ratios, points were assigned to each item ranging from 4 to 8. AUROCC [95% confidence interval] of the scoring system to diagnose bowel ischemia was 0.93 [0.91–0.95], p < 0.001. The optimal threshold after bootstrapping was ≥ 14 points; this yielded a sensitivity of 85.4%, a specificity of 94.8%, a positive likelihood ratio of 16.42, a negative likelihood ratio of 0.15, a Youden’s index of 0.802, and a diagnostic odds ratio of 106.62. Conclusions A biological scoring system based on PCT, ASAT, lactate, and myoglobin measurement allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and an early treatment in this high mortality disease.Lire moins >
Lire la suite >Background Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. Main issue for physicians regarding bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management, resulting in a poorer prognosis, especially after cardiac surgery. The aim of the present series was to propose a simple scoring system based on biological data for the diagnosis of bowel ischemia. Methods In a retrospective monocentric study, patients admitted in cardiac ICU, after cardiovascular surgery, were screened for inclusion. According to a 1:2 ratio (case–control), matching between two groups was based on sex, type of cardiovascular surgery, and the operative period (per month). Patients were divided into two groups: “ischemic group” which corresponds to patients with confirmed bowel ischemia and “non-ischemic group” which corresponds to patients without bowel ischemia. Primary objective was the conception of a scoring system for the diagnosis of bowel ischemia. Secondary objectives were to detail the postoperative morbidity and the diagnostic features for the distinction between acute mesenteric ischemia and ischemic colitis. Results Forty-eight patients (1.3%) had confirmed bowel ischemia (“ischemic group”). According to the 2:1 matching, 96 patients were included in the “non-ischemic group.” Aspartate aminotransferase > 449 UI/L, lactate > 4 mmol/L, procalcitonin > 4.7 μg/L, and myoglobin > 1882 μg/L were found to be independently associated with bowel ischemia. Based on their respective odds ratios, points were assigned to each item ranging from 4 to 8. AUROCC [95% confidence interval] of the scoring system to diagnose bowel ischemia was 0.93 [0.91–0.95], p < 0.001. The optimal threshold after bootstrapping was ≥ 14 points; this yielded a sensitivity of 85.4%, a specificity of 94.8%, a positive likelihood ratio of 16.42, a negative likelihood ratio of 0.15, a Youden’s index of 0.802, and a diagnostic odds ratio of 106.62. Conclusions A biological scoring system based on PCT, ASAT, lactate, and myoglobin measurement allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and an early treatment in this high mortality disease.Lire moins >
Langue :
Anglais
Audience :
Internationale
Vulgarisation :
Non
Établissement(s) :
Inserm
Université de Lille
CHU Lille
Université de Lille
CHU Lille
Équipe(s) de recherche :
Inflammatory digestive disease : pathophysiology and therapeutic targets developement
Date de dépôt :
2019-03-01T14:34:44Z
2024-02-09T15:03:10Z
2024-02-09T15:03:10Z
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