1
|
Teng Y, Li Y, Li K, Hu Q, Yan S, Liu G, Ji B, Gao G. Risk Factors for Acute Kidney Injury in Adult Patients Under Veno-Arterial Extracorporeal Membrane Oxygenation Support. J Cardiothorac Vasc Anesth 2024; 38:2231-2237. [PMID: 38942685 DOI: 10.1053/j.jvca.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To investigate the incidence and risk factors of acute kidney injury (AKI) stage 3 in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. DESIGN A retrospective case-control study. SETTING Single center, Fuwai Hospital. PARTICIPANTS Adult VA-ECMO patients age ≥18 years and older treated between January 2020 and December 2022 were included. INTERVENTIONS The patients were grouped by whether they developed AKI Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 or <3. Multivariate logistic regression was performed t"o evaluate risk factors of AKI stage 3. MEASUREMENTS AND MAIN RESULTS Among enrolled patients, 40 (53.3%) developed AKI stage 3. The in-hospital mortality of AKI stage 3 patients was significantly higher than that of AKI stage <3 patients (67.5% vs 34.3%; p = 0.004). Multivariate logistic regression analysis revealed that concomitant hypertension (odds ratio [OR], 0.250; 95% confidence interval [CI], 0.063, 0.987), p = 0.048), pre-ECMO hemoglobin (OR, 0.969; 95% CI, 0.947-0.992; p = 0.009), pre-ECMO lactate (OR, 1.173; 95% CI, 1.028-1.339; p = 0.018), and pre-ECMO creatinine (OR, 1.014; 95% CI, 1.003-1.025; p = 0.011) were independent risk factors for AKI stage 3. CONCLUSIONS This study found a high incidence (53.3%) of AKI stage 3 in adult patients with VA-ECMO support and an association with increased in-hospital mortality. Concomitant hypertension, low pre-ECMO hemoglobin, and elevated pre-ECMO lactate and pre-ECMO creatinine were independent risk factors for AKI stage 3 in patients receiving VA-ECMO. It is imperative to identify and adjust these risk factors to enhance outcomes for those supported by VA-ECMO.
Collapse
Affiliation(s)
- Yuan Teng
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan Li
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - KunYu Li
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Hu
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Shujie Yan
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Gang Liu
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Guodong Gao
- Department of Cardiopulmonary Bypass, National Center for Cardiovascular Diseases & Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
2
|
Kim DK, Cho YS, Lee BK, Jeung KW, Jung YH, Lee DH, Kim MC, Jeong IS, Chun BJ, Moon JM. Acute kidney injury as a prognostic predictor of in-hospital mortality and neurological outcomes in patients after extracorporeal cardiopulmonary resuscitation. Perfusion 2024:2676591241269806. [PMID: 39118357 DOI: 10.1177/02676591241269806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly being applied to patients with refractory cardiac arrest, but the survival rate to hospital discharge is only approximately 29%. Because ECPR requires intensive resources, it is important to predict outcomes. We therefore investigated the prognostic association between acute kidney injury (AKI) and ECPR to confirm the performance of AKI as a prognostic predictor of in-hospital mortality and neurological outcomes in ECPR. METHODS We conducted a retrospective observational study on patients undergoing ECPR for cardiac etiology at Chonnam National University Hospital from 2015 to 2021. The group diagnosed with AKI in any KDIGO category within the first 48 h after ECPR was compared to that without AKI, and the primary outcome of the study was in-hospital mortality. RESULTS Of 138 enrolled patients, 83 were studied. Hospital mortality occurred in 49 patients (59%), and 55 (66.3%) showed poor neurological outcomes. The AKI group displayed significantly elevated in-hospital mortality (77.8% vs 24.1%) and poor neurological outcomes (81.5% vs 37.9%) compared to the non-AKI group (p < 0.001). Regression analysis showed that AKI was associated with significantly higher rates of both in-hospital mortality (odds ratio (OR) range 10.75-12.88) and neurologic outcomes (OR range 5.9-6.22). CONCLUSIONS There was a significant association of AKI with both in-hospital mortality and poor neurologic outcome in patients after ECPR, and AKI can be used as an early prognostic predictor in these patients.
Collapse
Affiliation(s)
- Dong Ki Kim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Soo Cho
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Byeong Jo Chun
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jeong Mi Moon
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
3
|
Novy E, Abdul-Aziz MH, Cheng V, Burrows F, Buscher H, Corley A, Diehl A, Gilder E, Levkovich BJ, McGuinness S, Ordonez J, Parke R, Parker S, Pellegrino V, Reynolds C, Rudham S, Wallis SC, Welch SA, Fraser JF, Shekar K, Roberts JA. Population pharmacokinetics of fluconazole in critically ill patients receiving extracorporeal membrane oxygenation and continuous renal replacement therapy: an ASAP ECMO study. Antimicrob Agents Chemother 2024; 68:e0120123. [PMID: 38063399 PMCID: PMC10777822 DOI: 10.1128/aac.01201-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/07/2023] [Indexed: 01/11/2024] Open
Abstract
This multicenter study describes the population pharmacokinetics (PK) of fluconazole in critically ill patients receiving concomitant extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) and includes an evaluation of different fluconazole dosing regimens for achievement of target exposure associated with maximal efficacy. Serial blood samples were obtained from critically ill patients on ECMO and CRRT receiving fluconazole. Total fluconazole concentrations were measured in plasma using a validated chromatographic assay. A population PK model was developed and Monte Carlo dosing simulations were performed using Pmetrics in R. The probability of target attainment (PTA) of various dosing regimens to achieve fluconazole area under the curve to minimal inhibitory concentration ratio (AUC0-24/MIC) >100 was estimated. Eight critically ill patients receiving concomitant ECMO and CRRT were included. A two-compartment model including total body weight as a covariate on clearance adequately described the data. The mean (±standard deviation, SD) clearance and volume of distribution were 2.87 ± 0.63 L/h and 15.90 ± 13.29 L, respectively. Dosing simulations showed that current guidelines (initial loading dose of 12 mg/kg then 6 mg/kg q24h) achieved >90% of PTA for a MIC up to 1 mg/L. None of the tested dosing regimens achieved 90% of PTA for MIC above 2 mg/L. Current fluconazole dosing regimen guidelines achieved >90% PTA only for Candida species with MIC <1 mg/L and thus should be only used for Candida-documented infections in critically ill patients receiving concomitant ECMO and CRRT. Total body weight should be considered for fluconazole dose.
Collapse
Affiliation(s)
- Emmanuel Novy
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
- Université de Lorraine, SIMPA, Nancy, France
- Departement of anesthesiology, Critical care and peri-operative medicine, University hospital of Nancy, Nancy, France
| | - Mohd H. Abdul-Aziz
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Vesa Cheng
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Fay Burrows
- Department of Pharmacy, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Hergen Buscher
- Department of Intensive Care Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia
- University of New South Wales, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Amanda Corley
- The Prince Charles Hospital, Critical Care Research Group and Adult Intensive Care Services, Brisbane, Queensland, Australia
| | - Arne Diehl
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eileen Gilder
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Bianca J. Levkovich
- Experiential Development and Graduate Education and Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shay McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Jenny Ordonez
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The University of Auckland, School of Nursing, Auckland, New Zealand
| | - Suzanne Parker
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claire Reynolds
- Department of Intensive Care Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Sam Rudham
- Department of Intensive Care Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Steven C. Wallis
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Susan A. Welch
- Department of Pharmacy, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - John F. Fraser
- The Prince Charles Hospital, Critical Care Research Group and Adult Intensive Care Services, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kiran Shekar
- The Prince Charles Hospital, Critical Care Research Group and Adult Intensive Care Services, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jason A. Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| |
Collapse
|
4
|
Surjit A, Prasannan B, Abraham J, Balagopal A, Unni VN. Acute Kidney Injury in Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study. Indian J Crit Care Med 2024; 28:26-29. [PMID: 38510762 PMCID: PMC10949276 DOI: 10.5005/jp-journals-10071-24612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/06/2023] [Indexed: 03/22/2024] Open
Abstract
Aims and background Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal therapy to support oxygenation of patients with severe cardiac or respiratory failure. Studies have shown that acute kidney injury (AKI) can worsen the outcome in these patients. This study aims to assess the incidence and outcome of AKI in patients on ECMO support. Materials and methods This retrospective study included 64 patients who underwent ECMO for more than 24 hours. Patients who died within 48 hours of initiation of ECMO and patients with end-stage renal disease (ESRD) on maintenance hemodialysis were excluded. Acute kidney injury was diagnosed and categorized according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results Of the 64 patients studied, 38 patients (59.38%) developed AKI and 17 patients (44.73%) among them developed AKI within 24 hours of initiation of ECMO. Age, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, hypertension, use of nephrotoxic agents, inotropic support, and poor cardiac function were the risk factors associated with the development of AKI. Diabetes mellitus, type of ECMO used, and duration of ECMO were not found to be risk factors for AKI. Renal replacement therapy was initiated in 31 patients (81.58%). The overall mortality in the whole group was 67.19%, while it was 81.58% among the patients with AKI. Conclusion Acute kidney injury was found to be an independent risk factor for mortality in patients on ECMO. Early identification of the risk factors for AKI and management may help to improve the survival rate. Clinical significance The occurrence of AKI among patients on ECMO support increases the risk of mortality significantly. Hence, measures to prevent AKI, as well as early detection and appropriate management of AKI, would improve patient outcomes. How to cite this article Surjit A, Prasannan B, Abraham J, Balagopal A, Unni VA. Acute Kidney Injury in Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study. Indian J Crit Care Med 2024;28(1):26-29.
Collapse
Affiliation(s)
- Aswin Surjit
- Department of Internal Medicine, Aster Medcity, Kochi, Kerala, India
| | - Bipi Prasannan
- Department of Nephrology, Aster Medcity, Kochi, Kerala, India
| | - Jobin Abraham
- Department of Critical Care, Aster Medcity, Kochi, Kerala, India
| | | | | |
Collapse
|
5
|
Vaynrub A, Ning Y, Kurlansky P, Wang AS, Beck J, Fried JA, Takeda K. Acute kidney injury during extracorporeal life support in cardiogenic shock: Does flow matter? Perfusion 2023:2676591231220793. [PMID: 38084918 DOI: 10.1177/02676591231220793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND This study examines the role of extracorporeal life support flow in the development of acute kidney injury in cardiogenic shock. METHODS We performed a retrospective analysis of 465 patients placed on extracorporeal life support at our institution between January 2015 and December 2020 for cardiogenic shock. Flow index was calculated by dividing mean flow by body surface. Stages of acute kidney injury were determined according to Kidney Disease: Improving Global Outcomes (KDIGO) organization guidelines. RESULTS There were 179 (38.5%) patients who developed acute kidney injury, 63.1% of which were classified as Stage 3--the only subgroup associated with 1-year mortality (hazard ratio = 2.03, p < .001). Risk of kidney injury increased up to a flow index of 1.6 L/min/m2, and kidney injury was more common among patients with flow index greater than 1.6 L/min/m2 (p = .034). Those with kidney injury had higher baseline lactate levels (4.4 vs 3.1, p = .04), and Stage 3 was associated wit higher baseline creatinine (p < .001). CONCLUSIONS In our cohort, kidney injury was common and Stage 3 kidney injury was associated with worse outcomes compared to other stages. Low flow was not associated with increased risk of kidney injury. Elevated baseline lactate and creatinine among patients with acute kidney injury suggest underlying illness severity, rather than flow, may influence kidney injury risk.
Collapse
Affiliation(s)
- Anna Vaynrub
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, United States
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, United States
| | - Paul Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, United States
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, United States
| | - Amy S Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, United States
| | - James Beck
- Clinical Perfusion and Anesthesia Support Services, New York-Presbyterian Hospital, New York, NY, United States
| | - Justin A Fried
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, United States
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, United States
| |
Collapse
|
6
|
Sitbon A, Coutrot M, Montero S, Chommeloux J, Lebreton G, Huang F, Frapard T, Assouline B, Pineton De Chambrun M, Hekimian G, Luyt CE, Combes A, Schmidt M. Early renal recovery after acute kidney injury in patients on venoarterial extracorporeal membrane oxygenation: A retrospective study. J Crit Care 2023; 78:154368. [PMID: 37540960 DOI: 10.1016/j.jcrc.2023.154368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE The impact of VA-ECMO on early renal recovery (within 7 days after ECMO onset) in patients with pre-ECMO acute kidney injury and cardiogenic shock is unknown. MATERIAL AND METHODS This retrospective single-center study included adult patients with cardiogenic shock rescued by VA-ECMO and severe AKI occurring before ECMO implantation (pre-ECMO AKI). Patients with early renal recovery (defined as at least a 50% decrease in peak serum creatinine or weaning from renal replacement therapy) were compared to patients without early renal recovery. RESULTS During 7 years, 145 patients with severe pre-ECMO AKI were included. Eighty-two patients had no early renal recovery whereas 63 had early renal recovery within 7 days after VA-ECMO onset. The median time to early renal recovery was 4 (3,6) days. Nephrotoxic antibiotics (HR = 0.35 [95% CI, 0.21-0.59], p < 0.001), median fluid balance during the first 7 days of VA-ECMO (HR = 0.77 [95% CI, 0.64-0.93], p = 0.008), pre-ECMO AKI stage 3 (HR = 0.36 [95% CI, 0.20-0.64], p < 0.001) and median vasoactive-inotropic score (HR = 0.99 [95% CI, 0.98,1.00], p = 0.035) were independently associated with no early renal recovery. CONCLUSIONS Only 43% of patients with severe pre-ECMO AKI had early renal recovery after VA-ECMO initiation.
Collapse
Affiliation(s)
- Alexandre Sitbon
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France
| | - Maxime Coutrot
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France
| | - Santiago Montero
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
| | - Juliette Chommeloux
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Thoracic and Cardiovascular Department, 75651 Paris Cedex 13, France
| | - Florent Huang
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France
| | - Thomas Frapard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France
| | - Benjamin Assouline
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France
| | - Marc Pineton De Chambrun
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France
| | - Guillaume Hekimian
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France
| | - Charles Edouard Luyt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France
| | - Alain Combes
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France.
| |
Collapse
|
7
|
Chen W, Pei M, Chen C, Wang B, Shi L, Qiu G, Duan W, Chen S, Wei Q, Zeng X, Pang H, Wei Y, Wu R, Zhu R, Ji Q, Lyu L. One-Year Survival for Developing Acute Kidney Injury in Adult Patients with AMI Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation. Int J Gen Med 2023; 16:4537-4548. [PMID: 37818108 PMCID: PMC10561759 DOI: 10.2147/ijgm.s427999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023] Open
Abstract
Objective The incidence of cardiogenic shock cases treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been on the rise. Acute kidney injury (AKI) is a significant complication of cardiogenic shock and a frequent serious complication in patients requiring ECMO-supported therapy. AKI is strongly associated with unfavorable patient prognosis. However, there is a paucity of data on the influence of AKI on the prognosis of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) who are receiving ECMO support, particularly with regard to long-term outcomes. Methods This retrospective observational study included 103 patients in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 and June 2022. AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Cox regression and logistic regression were used to identify risk factors. Results In this study, the incidence of AKI was 63.11%, with AKI stage 1, 2, and 3 accounting for 21.36%, 12.62%, and 29.13%, respectively. Patients with severe AKI had significantly higher in-hospital mortality (43.33% vs 27.40%, P < 0.001), 30-day mortality (60.00% vs 31.51%, P = 0.001), and 1-year mortality (63.67% vs 34.25%, P<0.001) than those without severe AKI. Furthermore, severe AKI significantly increased the risk of one-year mortality (HR 10.816, CI 3.118-37.512, P<0.001). Baseline serum creatinine, baseline platelet, and active cardiopulmonary resuscitation were independent predictors of one-year mortality. In addition, baseline white blood cell count, baseline aspartate aminotransferase, baseline alanine aminotransferase (ALT), baseline serum creatinine, preoperative lactate, and postoperative mean arterial pressure were independent risk factors of severe AKI during hospitalization. Conclusion In patients with AMI-CS receiving ECMO support, AKI is highly prevalent. Development of severe AKI significantly increased the risk of one-year mortality.
Collapse
Affiliation(s)
- Wan Chen
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Mingyu Pei
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Chunxia Chen
- Department of Pharmacy, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Bo Wang
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Lei Shi
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Guozheng Qiu
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Wenlong Duan
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Shengxin Chen
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Qiao Wei
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Xi Zeng
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Huifeng Pang
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Yanlin Wei
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Ruihua Wu
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Ruikai Zhu
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| | - Qingwei Ji
- Department of Cardiovascular Medicine, The People’s Hospital of Guang Xi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guangxi Academy of Medical Sciences Nanning, Nanning, People’s Republic of China
| | - Liwen Lyu
- Department of Emergency, the People’s Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People’s Republic of China
| |
Collapse
|
8
|
Chen W, Pei M, Chen C, Zhu R, Wang B, Shi L, Qiu G, Duan W, Tang Y, Ji Q, Lv L. Independent risk factors of acute kidney injury among patients receiving extracorporeal membrane oxygenation. BMC Nephrol 2023; 24:81. [PMID: 36997848 PMCID: PMC10064517 DOI: 10.1186/s12882-023-03112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Acute kidney injury (AKI) is one of the most frequent complications in patients treated with extracorporeal membrane oxygenation (ECMO) support. The aim of this study was to investigate the risk factors of AKI in patients undergoing ECMO support. METHODS We performed a retrospective cohort study which included 84 patients treated with ECMO support at intensive care unit in the People's Hospital of Guangxi Zhuang Autonomous Region from June 2019 to December 2020. AKI was defined as per the standard definition proposed by the Kidney Disease Improving Global Outcome (KDIGO). Independent risk factors for AKI were evaluated through multivariable logistic regression analysis with stepwise backward approach. RESULTS Among the 84 adult patients, 53.6% presented AKI within 48 h after initiation of ECMO support. Three independent risk factors of AKI were identified. The final logistic regression model included: left ventricular ejection fraction (LVEF) before ECMO initiation (OR, 0.80; 95% CI, 0.70-0.90), sequential organ failure assessment (SOFA) score before ECMO initiation (OR, 1.41; 95% CI, 1.16-1.71), and serum lactate at 24 h after ECMO initiation (OR, 1.27; 95% CI, 1.09-1.47). The area under receiver operating characteristics of the model was 0.879. CONCLUSION Severity of underlying disease, cardiac dysfunction before ECMO initiation and the blood lactate level at 24 h after ECMO initiation were independent risk factors of AKI in patients who received ECMO support.
Collapse
Affiliation(s)
- Wan Chen
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Mingyu Pei
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Chunxia Chen
- Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous Region, 530021, Nanning, China
| | - Ruikai Zhu
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Bo Wang
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Lei Shi
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Guozheng Qiu
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Wenlong Duan
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Yutao Tang
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China
| | - Qinwei Ji
- Department of Cardiology, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China.
| | - Liwen Lv
- Department of Emergency, Research Center of Cardiovascular Disease, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 530021, Nanning, China.
| |
Collapse
|
9
|
Pang S, Miao G, Zhao X. Effects and safety of extracorporeal membrane oxygenation in the treatment of patients with ST-segment elevation myocardial infarction and cardiogenic shock: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:963002. [PMID: 36237911 PMCID: PMC9552800 DOI: 10.3389/fcvm.2022.963002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022] Open
Abstract
Background There is a lack of large randomized controlled trials (RCTs) that comprehensively evaluate the effects of venoarterial extracorporeal membrane oxygenation (V-A ECMO)- assisted treatment of patients with ST-segment elevation myocardial infarction (STEMI) combined with Cardiogenic shock (CS). This meta-analysis aims to identify predictors of short-term mortality, and the incidence of various complications in patients with STEMI and CS treated with V-A ECMO. Methods We searched PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and the Wanfang Database from 2008 to January 2022 for studies evaluating patients with STEMI and CS treated with V-A ECMO. Studies that reported on mortality in ≥ 10 adult (>18 years) patients were included. Newcastle-Ottawa Scale was used by two independent reviewers to assess methodological quality. Mantel-Haenszel models were used to pool the data for meta-analysis. Results Sixteen studies (1,162 patients) were included with a pooled mortality estimate of 50.9%. Age > 65 years, BMI > 25 kg/m2, lactate > 8 mmol/L, anterior wall infarction, longer CPR time, and longer time from arrest to extracorporeal cardiopulmonary resuscitation (ECPR) were risk predictors of mortality. Achieving TIMI-3 flow after percutaneous coronary intervention (PCI) was a protective factor of mortality. The prevalence of bleeding, cerebral infarction, leg ischemia, and renal failure were 22, 9.9, 7.4, and 49.4%, respectively. Conclusion Our study identified Age, BMI, lactate, anterior wall infarction, TIMI-3 flow after PCI, CPR time, and time from arrest to ECPR significantly influence mortality in STEMI patients with CS requiring V-A ECMO. These factors may help clinicians to detect patients with poor prognoses earlier and develop new mortality prediction models.
Collapse
|
10
|
Different Acute Kidney Injury Patterns after Renal Ischemia Reperfusion Injury and Extracorporeal Membrane Oxygenation in Mice. Int J Mol Sci 2022; 23:ijms231911000. [PMID: 36232304 PMCID: PMC9570202 DOI: 10.3390/ijms231911000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) is associated with acute kidney injury (AKI) in thoracic organ transplantation. However, multiple other factors contribute to AKI development after these procedures such as renal ischemia-reperfusion injury (IRI) due to hypo-perfusion of the kidney during surgery. In this study, we aimed to explore the kidney injury patterns in mouse models of ECMO and renal IRI. Kidneys of C57BL/6 mice were examined after moderate (35 min) and severe (45 min) unilateral transient renal pedicle clamping and 2 h of veno-venous ECMO. Renal injury markers, neutrophil infiltration, tubular transport function, pro-inflammatory cytokines, and renal heme oxygenase-1 (HO-1) expression were determined by immunofluorescence and qPCR. Both procedures caused AKI, but with different injury patterns. Severe neutrophil infiltration of the kidney was evident after renal IRI, but not following ECMO. Tubular transport function was severely impaired after renal IRI, but preserved in the ECMO group. Both procedures caused upregulation of pro-inflammatory cytokines in the renal tissue, but with different time kinetics. After ECMO, but not IRI, HO-1 was strongly induced in tubular cells indicating contact with hemolysis-derived proteins. After IRI, HO-1 was expressed on infiltrating myeloid cells in the tubulo-interstitial space. In conclusion, renal IRI and ECMO both caused AKI, but kidney damage after renal IRI was more pronounced including severe neutrophil infiltration and tubular transport impairment. Enhanced HO-1 expression in tubular cells after ECMO encourages limitation of hemolysis as a therapeutic approach to reduce ECMO-associated AKI.
Collapse
|
11
|
Muciño-Bermejo MJ. Extracorporeal organ support and the kidney. FRONTIERS IN NEPHROLOGY 2022; 2:924363. [PMID: 37674997 PMCID: PMC10479766 DOI: 10.3389/fneph.2022.924363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/01/2022] [Indexed: 09/08/2023]
Abstract
The concept of extracorporeal organ support (ECOS) encompasses kidney, respiratory, cardiac and hepatic support. In an era of increasing incidence and survival of patients with single or multiple organ failure, knowledge on both multiorgan crosstalk and the physiopathological consequences of extracorporeal organ support have become increasingly important. Immerse within the cross-talk of multiple organ failure (MOF), Acute kidney injury (AKI) may be a part of the clinical presentation in patients undergoing ECOS, either as a concurrent clinical issue since the very start of ECOS or as a de novo event at any point in the clinical course. At any point during the clinical course of a patient with single or multiple organ failure undergoing ECOS, renal function may improve or deteriorate, as a result of the interaction of multiple factors, including multiorgan crosstalk and physiological consequences of ECOS. Common physiopathological ways in which ECOS may influence renal function includes: 1) multiorgan crosstalk (preexisting or de-novo 2)Hemodynamic changes and 3) ECOS-associated coagulation abnormalities and 3) Also, cytokine profile switch, neurohumoral changes and toxins clearance may contribute to the expected physiological changes related to ECOS. The main objective of this review is to summarize the described mechanisms influencing the renal function during the course of ECOS, including renal replacement therapy, extracorporeal membrane oxygenation/carbon dioxide removal and albumin dialysis.
Collapse
Affiliation(s)
- Maria-Jimena Muciño-Bermejo
- Intensive Care Unit, The American British Cowdray Medical Center, Mexico City, Mexico
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Health Sciences Department, Anahuac University, Mexico City, Mexico
- Medical Division, Medecins SansFontières – OCBA (Operational Centre Barcelona-Athens), Barcelona, Spain
| |
Collapse
|
12
|
End-stage Renal Disease and Long-term Survival Among Survivors of Extracorporeal Membrane Oxygenation. ASAIO J 2021; 68:1149-1157. [PMID: 34860708 DOI: 10.1097/mat.0000000000001622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate the prevalence and associated factors of newly diagnosed end-stage renal disease (ESRD) requiring renal-replacement therapy (RRT) among survivors of extracorporeal membrane oxygenation (ECMO) and determine whether newly diagnosed ESRD is associated with poorer long-term survival outcomes. All adult patients who underwent ECMO between 2005 and 2018 were included, and ECMO survivors were those who survived more than 365 days after ECMO support. ECMO survivors with a history of pre-ECMO RRT were excluded. A total of 5,898 ECMO survivors were included in the analysis. At the 1-year post-ECMO follow-up, 447 patients (7.6%) were newly diagnosed with ESRD requiring RRT. Preexisting renal disease (odds ratio [OR]: 2.83), increased duration of continuous RRT during hospitalization (OR: 1.16), the cardiovascular group (vs. respiratory group; OR: 1.78), and the postcardiac arrest group (vs. respiratory group; OR: 2.52) were associated with newly diagnosed ESRD. Moreover, patients with newly diagnosed ESRD were associated with a 1.56-fold higher risk of 3-year all-cause mortality than those in the control group (hazard ratio: 1.56). At the 1-year post-ECMO follow-up, 7.6% of ECMO survivors were newly diagnosed with ESRD requiring RRT. Moreover, post-ECMO ESRD was associated with poorer long-term survival among ECMO survivors.
Collapse
|