Wayne et al developed a vascular disease score for identifying mesenteric ischemia in a patient with pneumatosis intestinalis (PI) and/or portal venous gas (PVG). The authors are from the University of Louisville, Rush University Medical Center, and the University of Iowa.
Patient selection: pneumatosis intestinalis and/or portal venous gas
Parameters:
(1) smoking
(2) diabetes mellitus
(3) hypertension
(4) hyperlipidemia
(5) coronary artery disease (CAD)
(6) peripheral vascular/arterial disease (PVD or PAD)
(7) risk factors for low-flow (perfusion) of gut (moderate or severe CHF, intravenous pressors, cardiac arrhythmias, sepsis, shock, etc)
(8) vasculitis or venous occlusion to mesenteric vessels
(9) abdominal exam (abdominal pain OR abnormal exam if sedated or intubated)
(10) lactate concentration in mg/dL
(11) pneumatosis of the small intestine
|
Parameter |
Finding |
Points |
|
smoking |
no |
0 |
|
|
yes |
0.5 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
0.5 |
|
hypertension |
no |
0 |
|
|
yes |
0.5 |
|
hyperlipidemia |
no |
0 |
|
|
yes |
0.5 |
|
coronary artery disease |
no |
0 |
|
|
yes |
2 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
2 |
|
low-flow to gut |
no |
0 |
|
|
yes |
2 |
|
vasculitis or venous occlusion |
no |
0 |
|
|
yes |
2 |
|
abdominal exam |
negative |
0 |
|
|
positive |
1 |
|
lactate concentration |
< 3.0 mg/dL (see note) |
0 |
|
|
>= 3.0 mg/dL (see note) |
3 |
|
pneumatosis of small intestine |
no |
0 |
|
|
yes |
1 |
where:
• The method and sample for lactate concentration are not stated.
• The reference range is given on page 442 as < 2.2 mg/dL.
• The reference range for plasma lactate is 4.5 to 19.8 mg/dL (or 0.5 to 2.2 mmol/L, using a conversion factor of 0.111, according to Wu.
• Other papers using lactate in PI use mmol/L.
• The units in the implementation will be mmol/L and not mg/dL. The sample will be assumed to be plasma.
• The abdominal exam needs to include if a person is unconscious as well as sedated.
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The higher the score the greater the risk of mesenteric ischemia.
|
Score |
Mesenteric Ischemia |
|
0 to 3 |
unlikely |
|
4 to 6 |
possible |
|
7 to 15 |
strongly suspect |
Specialty: Gastroenterology
