Mesenteric Ischemia and Risk Factors: Scoping Review with ☸SAIMSARA

The aim of this paper is to synthesize research findings on the risk factors for the development of mesenteric ischemia and the clinical, laboratory, and radiological predictors of mortality and intestinal necrosis in affected patients. The review utilises 120 references. The evidence map suggests that mesenteric ischemia risk and prognosis are dominated by a recurring triad of systemic vulnerability, hemodynamic compromise, and markers of advanced bowel injury. Among the clearest signals, lactate thresholds above 2–3 mmol/L, SOFA values in higher ranges, and older age were repeatedly associated with intestinal necrosis and death, with reported effect sizes reaching OR 49.66 for lactate >2 mmol/L in one cohort and OR 23.3 for SOFA ≥10 in NOMI-focused work. The mapped literature also consistently indicates that cardiovascular disease, renal dysfunction, vasopressor exposure, dialysis-related hypotension, and recent cardiac or aortic surgery define particularly high-risk settings, while CT findings such as decreased bowel wall enhancement, bowel dilation, pneumatosis, and ascites identify patients who may already have irreversible transmural injury. Clinically, these patterns support a low threshold for urgent CTA, serial metabolic monitoring, and rapid escalation to revascularization or surgery when high-risk clinical and radiologic features converge. Although the overall evidence remains heterogeneous and largely observational, it strongly highlights the practical value of early recognition and structured risk stratification. Future research should prioritize prospective, subtype-specific models that integrate bedside findings, laboratory markers, and imaging features to better distinguish reversible ischemia from irreversible necrosis and to guide timing of intervention.