1
|
Sommerfeld O, Neumann C, Pfeifer MD, Faerber G, Kirov H, von Loeffelholz C, Doenst T, Sponholz C. Predictive Value of Serial Model of End-Stage Liver Disease Score Determination in Patients with Postcardiotomy Extracorporeal Membrane Oxygenation. J Clin Med 2024; 13:1856. [PMID: 38610621 PMCID: PMC11012714 DOI: 10.3390/jcm13071856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The use of extracorporeal membrane oxygenation (ECMO) in low cardiac output states after cardiac surgery may aid in patient recovery. However, in some patients, the clinical state may worsen, resulting in multiple organ failure and high mortality rates. In these circumstances, calculating a model of end-stage liver disease (MELD) score was shown to determine organ dysfunction and predicting mortality. (2) Methods: We evaluated whether serial MELD score determination increases mortality prediction in patients with postcardiotomy ECMO support. (3) Results: Statistically, a cutoff of a 2.5 MELD score increase within 48 h of ECMO initiation revealed an AUC of 0.722. Further, we found a significant association between hospital mortality and 48 h MELD increase (HR: 2.5, 95% CI: 1.33-4.75, p = 0.005) after adjustment for possible confounders. (4) Conclusions: Therefore, serial MELD score determinations on alternate days may be superior to single measurements in this special patient cohort.
Collapse
Affiliation(s)
- Oliver Sommerfeld
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (C.N.); (M.-D.P.); (C.v.L.); (C.S.)
| | - Caroline Neumann
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (C.N.); (M.-D.P.); (C.v.L.); (C.S.)
| | - Marcel-Dominic Pfeifer
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (C.N.); (M.-D.P.); (C.v.L.); (C.S.)
| | - Gloria Faerber
- Clinic for Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (G.F.); (H.K.); (T.D.)
| | - Hristo Kirov
- Clinic for Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (G.F.); (H.K.); (T.D.)
| | - Christian von Loeffelholz
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (C.N.); (M.-D.P.); (C.v.L.); (C.S.)
| | - Torsten Doenst
- Clinic for Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (G.F.); (H.K.); (T.D.)
| | - Christoph Sponholz
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (C.N.); (M.-D.P.); (C.v.L.); (C.S.)
| |
Collapse
|
2
|
Altshuler PJ, Preston WA, Pace DJ, Kittle H, Shah AP, Glorioso JM, Maley WR, Frank AM, Ramirez CB, West S, Hasz R, Bodzin AS. Extracorporeal membrane oxygenation for cardiopulmonary failure in organ donation: Assessing liver transplant outcomes. Liver Transpl 2023; 29:1151-1160. [PMID: 37387680 DOI: 10.1097/lvt.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
Liver transplantation continues to face significant organ shortages and efficient utilization of marginal donors is paramount. This study evaluates the practice patterns and outcomes in liver transplantation when utilizing allografts from marginal donors who required extracorporeal membrane oxygenation (ECMO) support. We performed a retrospective review of the Gift of Life (PA, NJ, DE) organ-procuring organization database for transplants performed using donors supported on ECMO for nondonation purposes. These were cross-referenced to the transplant recipients within the Organ Procurement and Transplantation Network database, and the outcomes of liver transplants using donors on ECMO support were compared with those not requiring ECMO. Organ use and nonuse patterns were then evaluated in ECMO-supported donors, identifying the factors associated with nonuse compared with the factors associated with graft failure. Thirty-nine of the 84 ECMO-supported donors contributing at least one intra-abdominal organ for transplant donated a liver. Graft survival and patient survival up to 5 years were comparable between transplants from ECMO and non-ECMO-supported donors, and no cases of primary nonfunction were seen in the ECMO group. ECMO support was not associated with 1-year graft failure on regression modeling. Additional regression analyses within the ECMO donor population identified bacteremia (HR: 19.81) and elevated total bilirubin at donation (HR: 2.44) as predictive of post-transplant graft failure. Livers from donors supported on ECMO before donation appear safe to use in select transplant settings. Better understanding of the impact of predonation ECMO on liver allograft function will help guide the optimal use of these scarcely used donors.
Collapse
Affiliation(s)
- Peter J Altshuler
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - William A Preston
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Devon J Pace
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Haley Kittle
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Ashesh P Shah
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Jaime M Glorioso
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Warren R Maley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Adam M Frank
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Carlo B Ramirez
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Richard Hasz
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Adam S Bodzin
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| |
Collapse
|
3
|
Schupp T, Rusnak J, Weidner K, Ruka M, Egner-Walter S, Dudda J, Forner J, Bertsch T, Mashayekhi K, Ayoub M, Akin M, Kittel M, Behnes M, Akin I. Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock. J Clin Med 2023; 12:5275. [PMID: 37629321 PMCID: PMC10455678 DOI: 10.3390/jcm12165275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
This study investigates the prognostic value of the aspartate-to-alanine aminotransferase ratio (i.e., AST/ALT ratio) and bilirubin in patients with cardiogenic shock (CS). Despite ongoing improvements regarding the treatment of CS patients, invasive care unit (ICU) mortality in CS patients remains unacceptably high. Limited data regarding the prognostic value of the AST/ALT ratio and bilirubin in patients suffering from CS is available. The authors hypothesize the measurement of liver enzymes during the course of CS may be an easy and feasible method to assess right-heart dysfunction and prognosis in patients with CS. Consecutive patients with CS from 2019 to 2021 were included. Blood samples were retrieved from the day of disease onset (day 1), days 2, 3, 4 and 8. The prognostic value of the AST/ALT ratio and bilirubin was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman's correlations, Kaplan-Meier analyses, as well as multivariable Cox proportional regression analyses. A total of 157 CS patients were included, with an overall rate of all-cause mortality at 30 days of 51%. The median AST/ALT ratio on day 1 was 1.4, and the median bilirubin was 0.63 mg/dL. No association of the baseline AST/ALT ratio (HR = 1.005; 95% CI 0.649-1.558; p = 0.981) and bilirubin (HR = 1.320; 95% CI 0.834-2.090; p = 0.236) with the risk of 30-day all-cause mortality was found. In contrast, the AST/ALT ratio on day 4 was associated with the risk of 30-day all-cause mortality (HR = 2.826; 95% CI 1.227-6.510; p = 0.015), which was still evident after the multivariable adjustment (HR = 2.830; 95% CI 1.054-7.690; p = 0.039). The AST/ALT ratio during the course of ICU hospitalization from day 4-but not the baseline AST/ALT ratio and bilirubin-was associated with an increased risk of 30-day all-cause mortality in CS patients.
Collapse
Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Maximilian Kittel
- Institute for Clinical Chemistry, Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (T.S.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| |
Collapse
|
4
|
Raman J, Saxena P, Dobrilovic N. ECMO as a bridge to cardiac surgery: stabilizing unstable patients for a definitive procedure. Indian J Thorac Cardiovasc Surg 2023; 39:63-72. [PMID: 37525716 PMCID: PMC10387022 DOI: 10.1007/s12055-023-01523-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 08/02/2023] Open
Abstract
Introduction Extracorporeal membrane oxygenation (ECMO) in adults has been used in post-cardiotomy patients who decline hemodynamically. Cardiogenic shock in patients with potential surgically correctable cardiac conditions are at significantly higher risk for post-operative morbidity and mortality. We present experience with a pre-emptive approach of ECMO institution pre-operatively to stabilize patients with cardiogenic shock. Materials and methods This study expands on a pilot study with a group of twenty patients who were supported with ECMO pre-operatively in different institutions over a period between 2011 and 2021. The patients presented with cardiogenic shock. Peripheral veno-arterial (VA) ECMO support was used in all the patients. Cardiac surgery was performed via median sternotomy utilizing the in situ ECMO cannulae to institute cardiopulmonary bypass (CPB). Results Seventeen patients were weaned off ECMO support following a mean duration of support of 156 h. Fifteen patients survived to discharge. The 30-day mortality and in-hospital mortality were 25% (expected 67% by European System for Cardiac Operative Risk Evaluation (EuroSCORE) II). The causes of mortality included persistent bleeding in 2 patients due to liver dysfunction, and one with low platelet counts. The other two had multi-organ failure. Conclusions Variable period of pre-operative ECMO support provides hemodynamic stability and may prevent or reverse the multi-organ dysfunction if instituted on time in patients presenting with cardiogenic shock. This strategy allows cardiac surgery to be performed with acceptable risk.
Collapse
Affiliation(s)
- Jai Raman
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, University of Melbourne, Fitzroy, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, QLD Australia
| | - Nikola Dobrilovic
- Section of Cardiac Surgery, Evanston Northshore Health System, Chicago, IL USA
| |
Collapse
|
5
|
Neumann E, Sahli SD, Kaserer A, Braun J, Spahn MA, Aser R, Spahn DR, Wilhelm MJ. Predictors associated with mortality of veno-venous extracorporeal membrane oxygenation therapy. J Thorac Dis 2023; 15:2389-2401. [PMID: 37324096 PMCID: PMC10267924 DOI: 10.21037/jtd-22-1273] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/10/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) has rapidly increased in recent years. Today, applications of V-V ECMO include a variety of clinical conditions such as acute respiratory distress syndrome (ARDS), bridge to lung transplantation and primary graft dysfunction after lung transplantation. The purpose of the present study was to investigate in-hospital mortality of adult patients undergoing V-V ECMO therapy and to determine independent predictors associated with mortality. METHODS This retrospective study was conducted at the University Hospital Zurich, a designated ECMO center in Switzerland. Data was analyzed of all adult V-V ECMO cases from 2007 to 2019. RESULTS In total, 221 patients required V-V ECMO support (median age 50 years, 38.9% female). In-hospital mortality was 37.6% and did not statistically vary significantly between indications (P=0.61): 25.0% (1/4) for primary graft dysfunction after lung transplantation, 29.4% (5/17) for bridge to lung transplantation, 36.2% (50/138) for ARDS and 43.5% (27/62) for other pulmonary disease indications. Cubic spline interpolation showed no effect of time on mortality over the study period of 13 years. Multiple logistic regression modelling identified significant predictor variables associated with mortality: age [odds ratio (OR), 1.05; 95% confidence interval (CI): 1.02-1.07; P=0.001], newly detected liver failure (OR, 4.83; 95% CI: 1.27-20.3; P=0.02), red blood cell transfusion (OR, 1.91; 95% CI: 1.39-2.74; P<0.001) and platelet concentrate transfusion (OR, 1.93; 95% CI: 1.28-3.15; P=0.004). CONCLUSIONS In-hospital mortality of patients receiving V-V ECMO therapy remains relatively high. Patients' outcomes have not improved significantly in the observed period. We identified age, newly detected liver failure, red blood cell transfusion and platelet concentrate transfusion as independent predictors associated with in-hospital mortality. Incorporating such mortality predictors into decision making with regards to V-V ECMO use may increase its effectiveness and safety and may translate into better outcomes.
Collapse
Affiliation(s)
- Elena Neumann
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Sebastian D. Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Julia Braun
- Departments of Biostatistics and Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Muriel A. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Raed Aser
- Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Markus J. Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
ECMO Retrieval Program: What Have We Learned So Far. Life (Basel) 2023; 13:life13010157. [PMID: 36676106 PMCID: PMC9865097 DOI: 10.3390/life13010157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock or cardiac arrest. However, survival rates remain low. It is unclear to what extent ECMO patients benefit from the ECMO team learning curve. Therefore, we aimed to analyze our mobile ECMO program patients from the past seven years to evaluate if a learning curve benefits patients’ outcomes. We analyzed 111 patients from our databank who were supported with a VA-ECMO and brought to our hospital from January 2015 to December 2021. Patients were divided into two groups: survival (n = 70) and non-survival (n = 41). As expected, complications after ECMO implantation were more severe in the non-survivor group. The incidence of thromboembolic events (p = 0.002), hepatic failure (p < 0.001), renal failure (p = 0.002), dialysis (p = 0.002) and systemic inflammatory response syndrome (SIRS, p = 0.044) occurred significantly more often compared with the survivor group. We were able to show that despite our extensive experience in terms of ECMO retrieval program the high mortality and morbidity rates stay fairly the same over the years. This displays that we have to focus even more on patient selection and ECMO indication.
Collapse
|
7
|
Yoon YI, Lim JH, Lee SG, Kang PJ, Hwang GS, Ha SM, Do HY, Hong SK, Huh JW. Role of extracorporeal membrane oxygenation as a salvage therapy for liver transplantation recipients in a high-volume transplant center. Liver Transpl 2023; 29:67-79. [PMID: 36030502 DOI: 10.1002/lt.26567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 01/14/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has been used sporadically in adult orthotopic liver transplantation (OLT) recipients for the treatment of acute cardiopulmonary failure. This retrospective study aimed to identify OLT patients who would benefit from ECMO support. We reviewed 109 OLT patients who received ECMO support for more than 24 h from January 2007 to December 2020. Among the enrolled patients, 15 (13.8%) experienced 18 ECMO-related complications and 12 (11.0%) experienced ECMO reapplication after weaning during the same hospitalization period. The successful weaning rates were 50.98% in patients who received ECMO support during the peritransplantation period (0-30 days from transplantation) and 51.72% in patients who received ECMO support in the post-OLT period (more than 30 days after OLT); 24 (47.1%) and 23 (39.7%) patients survived until hospital discharge, respectively. The 109 enrolled OLT recipients who received ECMO support during the perioperative period had a 1-year survival rate of 42.6%. Multivariate analyses identified the following as significant and independent risk factors for in-hospital mortality: ECMO treatment prior to 2011 ( p = 0.04), septic shock as the indication for ECMO treatment ( p = 0.001), and a total bilirubin level of ≥5.0 mg/dl ( p = 0.02). The outcomes of adult OLT recipients with ECMO treatment were acceptable in terms of weaning success and survival until hospital discharge. This study confirmed that ECMO treatment for OLT recipients with septic shock and elevated bilirubin levels might be associated with a higher in-hospital mortality and demonstrated the importance of a multidisciplinary ECMO team approach.
Collapse
Affiliation(s)
- Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jung-Hyeon Lim
- Department of Thoracic and Cardiovascular Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Pil-Je Kang
- Department of Thoracic and Cardiovascular Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Su-Min Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Ha-Yeon Do
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Suk-Kyung Hong
- Division of Acute Care Surgery, Department of Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| |
Collapse
|
8
|
Huang R, Shao M, Zhang C, Fang M, Jin M, Han X, Liu N. Serum Total Bilirubin With Hospital Survival in Adults During Extracorporeal Membrane Oxygenation. Front Med (Lausanne) 2022; 9:914557. [PMID: 35814759 PMCID: PMC9263081 DOI: 10.3389/fmed.2022.914557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is widely used for refractory cardiopulmonary failure treatment. The disadvantage of ECMO is its higher risk profile and clinical resource consumption. This observation examines the role of serum total bilirubin (TBIL) as a predictor of adult patient outcomes on ECMO support. Methods This retrospective observation reports a single-center experience with adults on ECMO support between 2018 and 2021. Data were collected regarding demographics, ECMO details, laboratory parameters, and outcomes. We examined the elevation of TBIL to predict survival and variables associated with hyperbilirubinemia. Results The patients who died within 28 days had a twofold higher peak level of TBIL than those who survived [73.10 (38.60, 98.64) vs. 34.50 (24.03, 54.85); P = 0.003]. Univariate logistic regression analyses demonstrated that high TBIL was remarkably associated with an elevated risk of 28-day mortality (OR: 7.25; 95% CI: 2.31–25.49; P = 0.001) and total mortality (OR: 5.71; 95% CI: 1.82–20.66; P = 0.001). The TBIL value was 65 μmol/L as the best cut-off value, and the observation group was divided into a high TBIL subgroup (n = 21) or a low TBIL subgroup (n = 39). The demographic and clinical features did not show a difference, whereas Sequential Organ Failure Assessment (SOFA) and APACHE II scores and ALT, AST, and LAC before ECMO initiation correlated with high or low TBIL (P < 0.05). For coagulation function at the time of TBIL peak, the levels of prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin time activity (PTA), and fibrinogen (FIB) were different between the two subgroups (P < 0.05). The SOFA score was potentially associated with hyperbilirubinemia after ECMO initiation, and the prediction accuracy was 0.800. Conclusion Serum total bilirubin elevation appears after ECMO initiation and correlates with survival, while other markers of liver injury do not. Serum total bilirubin is an easy-to-measure biomarker to be a predictor of survival after ECMO initiation.
Collapse
Affiliation(s)
- Rui Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Min Shao,
| | - Cheng Zhang
- Anhui Provincial Cancer Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ming Fang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mengmeng Jin
- Department of Respiratory and Critical Care, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuan Han
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Nian Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Nian Liu,
| |
Collapse
|