Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study
Abstract
Aims: To evaluate whether preoperative CT-derived spleen density is associated with in-hospital mortality and bowel resection requirement in patients managed for acute mesenteric ischemia (AMI), and to explore its potential role as an imaging-based prognostic biomarker.
Methods: This hypothesis-generating retrospective cohort study included 71 consecutive AMI patients at Ankara Etlik City Hospital (January 2022- July 2025). Spleen density was measured by two independent observers on preoperative contrast enhanced CT (portal venous phase; 5 mm slices) at three standardised levels and expressed as mean Hounsfield units (HU). Groups were compared by Mann-Whitney U or Chi-square/Fisher's exact test. Multivariable binary logistic regression identified independent predictors of in-hospital mortality. ROC curves were generated with Youden-optimal cut-offs. A pre-specified sensitivity analysis was restricted to operated patients (n=62).
Results: In-hospital mortality was 52.1% (37/71). Median spleen density was 88.2 HU (IQR 53.0). Spleen density did not differ between survivors and non-survivors (90.2 vs. 80.5 HU; p=0.332) or in the operated-only sensitivity analysis (94.8 vs. 73.6 HU; p=0.275), nor between resection groups (p=0.074). Age (OR 1.078, 95% CI 1.024-1.135; p=0.004) and lactate (OR 1.453, 95% CI 1.012-2.088; p=0.043) were independent mortality predictors; spleen density was not (OR 0.999; p=0.877). Spleen density showed moderate inverse correlations with lactate, creatinine, and LDH.
Conclusion: Preoperative spleen density was not independently associated with mortality or bowel resection in this exploratory AMI cohort. Although the study was underpowered to detect small effect sizes, the observed correlations with metabolic derangement markers support further prospective investigation.
Keywords
Supporting Institution
This study received no external funding.
Ethical Statement
The study protocol was approved by the Institutional Ethics Committee of Ankara Etlik City Hospital (AEŞH-BADEK-2024-1088, approval date: November 27, 2024) and conducted in accordance with the Declaration of Helsinki. Due to the retrospective nature of the study, the requirement for informed consent was waived.
Thanks
The authors thank the Department of General Surgery staff for their support during data collection.
References
- Sise MJ. Acute mesenteric ischemia. Surg Clin North Am. 2014;94(1):165-181. doi:10.1016/j.suc.2013.10.012
- Bala M, Catena F, Kashuk J, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17(1):54. doi:10.1186/s13017-022-00443-x
- Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629-635. doi:10.1016/S1470-2045(08)70153-0
- Rinninella E, Cintoni M, Raoul P, et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis. Clin Nutr. 2020;39(7):2045-2054. doi:10.1016/j.clnu.2019.10.021
- Lewis SM, Williams A, Eisenbarth SC. Structure and function of the immune system in the spleen. Sci Immunol. 2019;4(33):eaau6085. doi:10.1126/sciimmunol.aau6085
- Swirski FK, Nahrendorf M, Etzrodt M, et al. Identification of splenic reservoir monocytes and their deployment to inflammatory sites. Science. 2009;325(5940):612-616. doi:10.1126/science.1175202
- He QN, Chen L, Hu HY, et al. Role of spleen density in predicting postoperative complications in patients with acute mesenteric ischemia. Vascular. 2024;32(5):1026-1035. doi:10.1177/17085381231164663
- Zheng J, He B, Deng L, et al. Prognostic value of diffuse reduction of spleen density on postoperative survival of pancreatic ductal adenocarcinoma: a retrospective study. Asia Pac J Clin Oncol. 2024;20(2):275-284. doi:10.1111/ajco.13936
Details
Primary Language
English
Subjects
General Surgery
Journal Section
Research Article
Publication Date
July 16, 2026
Submission Date
May 25, 2026
Acceptance Date
June 15, 2026
Published in Issue
Year 2026 Volume: 8 Number: 4
APA
Değirmencioğlu, G., Çanakcı, M. H., Kütük, D., Süer, M. S., Karakaya, A. T., & Balas, Ş. (2026). Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study. Anatolian Current Medical Journal, 8(4), 705-711. https://izlik.org/JA89FH68LU
AMA
1.Değirmencioğlu G, Çanakcı MH, Kütük D, Süer MS, Karakaya AT, Balas Ş. Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026;8(4):705-711. https://izlik.org/JA89FH68LU
Chicago
Değirmencioğlu, Gürkan, Mehmet Hanifi Çanakcı, Deniz Kütük, Muhammed Salih Süer, Ahmet Taha Karakaya, and Şener Balas. 2026. “Association Between Preoperative CT-Derived Spleen Density and In-Hospital Mortality in Acute Mesenteric Ischemia: A Hypothesis-Generating Retrospective Cohort Study”. Anatolian Current Medical Journal 8 (4): 705-11. https://izlik.org/JA89FH68LU.
EndNote
Değirmencioğlu G, Çanakcı MH, Kütük D, Süer MS, Karakaya AT, Balas Ş (July 1, 2026) Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study. Anatolian Current Medical Journal 8 4 705–711.
IEEE
[1]G. Değirmencioğlu, M. H. Çanakcı, D. Kütük, M. S. Süer, A. T. Karakaya, and Ş. Balas, “Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 4, pp. 705–711, July 2026, [Online]. Available: https://izlik.org/JA89FH68LU
ISNAD
Değirmencioğlu, Gürkan - Çanakcı, Mehmet Hanifi - Kütük, Deniz - Süer, Muhammed Salih - Karakaya, Ahmet Taha - Balas, Şener. “Association Between Preoperative CT-Derived Spleen Density and In-Hospital Mortality in Acute Mesenteric Ischemia: A Hypothesis-Generating Retrospective Cohort Study”. Anatolian Current Medical Journal 8/4 (July 1, 2026): 705-711. https://izlik.org/JA89FH68LU.
JAMA
1.Değirmencioğlu G, Çanakcı MH, Kütük D, Süer MS, Karakaya AT, Balas Ş. Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026;8:705–711.
MLA
Değirmencioğlu, Gürkan, et al. “Association Between Preoperative CT-Derived Spleen Density and In-Hospital Mortality in Acute Mesenteric Ischemia: A Hypothesis-Generating Retrospective Cohort Study”. Anatolian Current Medical Journal, vol. 8, no. 4, July 2026, pp. 705-11, https://izlik.org/JA89FH68LU.
Vancouver
1.Gürkan Değirmencioğlu, Mehmet Hanifi Çanakcı, Deniz Kütük, Muhammed Salih Süer, Ahmet Taha Karakaya, Şener Balas. Association between preoperative CT-derived spleen density and in-hospital mortality in acute mesenteric ischemia: a hypothesis-generating retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Jul. 1;8(4):705-11. Available from: https://izlik.org/JA89FH68LU
