Integrated prognostic markers in acute mesenteric ischaemia – a narrative review

INTRODUCTION: Acute mesenteric ischaemia (AMI) remains a surgical emergency with persistently high mortality, often attributable to delayed diagnosis and limited early prognostic clarity. Although advances in imaging and intervention have improved outcomes in selected cases, timely risk stratification remains critical to guide management and improve survival. METHODS: A literature review was conducted using PubMed to identify studies published between 2015 and 2025 that examined early prognostic indicators for AMI. Key biochemical, clinical, radiological, and scoring-based predictors of mortality were extracted and analysed. RESULTS: Nine studies met the inclusion criteria. A multifactorial prognostic framework emerged. Biochemical markers, including elevated lactate, a reduced bicarbonate-to-lactate ratio, high red cell distribution width, and a CRP/albumin ratio, were associated with increased mortality. Clinical factors – including advanced age, comorbid cardiovascular disease, haemodynamic instability, and the need for vasopressors – also showed substantial predictive value. Imaging findings (e.g., arterial occlusion, colonic involvement) and scoring systems, such as the Mannheim Peritonitis Index and the ASA classification, further enhanced risk stratification. CONCLUSION: Effective early risk assessment for AMI patients requires a multimodal approach integrating biochemical, clinical, and radiological data. Composite indices – such as the bicarbonate-to-lactate ratio – show promise in improving prognostic accuracy and guiding timely intervention. Prospective validation of these tools is essential to optimize outcomes and resource allocation in this high-risk population.