Prognosis of Patients on Extracorporeal Membrane Oxygenation: The Impact of Acute Kidney Injury on Mortality (original) (raw)
Related papers
PubMed, 2011
Background: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. Patients on ECMO with acute renal failure have high mortality rates. This study identifies specific predictors of hospital mortality for patients receiving ECMO and continuous arteriovenous hemofiltration (CAVH). Methods: This study reviewed the medical records of 123 critically ill patients on ECMO plus CAVH at a cardiovascular surgical intensive care unit (CVSICU) at a tertiary care university hospital between March 2003 and August 2010. Patient baseline, clinical, and laboratory data were collected retrospectively as survival predicators. Results: The overall mortality rate was 85.4%. The most common conditions requiring ECMO plus CAVH were cardiogenic shock and oliguria. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and organ system failure (OSF) score both indicated good discriminative power (area under the receiver operating characteristic curve [AUROC] 0.812 ± 0.048 and 0.758 ± 0.057, respectively). Multiple logistic regression analysis indicated that age, mean arterial pressure, and OSF score on day 1 of ECMO plus CAVH were independent risk factors for hospital mortality. Cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) between those with an OSF score ≤ 4 vs. those with an OSF score > 4. Conclusions: During ECMO plus CAVH support, both the OSF and APACHE II scores showed good discriminative power in predicting hospital mortality for these patients.
Evaluation of Outcome Scoring Systems for Patients on Extracorporeal Membrane Oxygenation
The Annals of Thoracic Surgery, 2007
Background. Extracorporeal membrane oxygenation (ECMO) has been used in critical conditions such as life-threatening respiratory failure or postcardiotomy cardiogenic shock. This investigation compares the predictive value of Acute Physiology, Age and Chronic Health Evaluation IV (APACHE IV), earlier APACHE models, Sequential Organ Failure Assessment (SOFA), and the risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function, and endstage renal failure (RIFLE) classification obtained on the first day of ECMO support for hospital mortality in critically ill patients. Methods. We reviewed the medical records of 78 critically ill patients on ECMO support at the specialized intensive care unit in a tertiary care university hospital from March 2002 to October 2005. Demographic, clinical, and laboratory variables and five scoring systems were retrospectively gathered as predicators of survival on ECMO day 1. Results. The overall mortality rate was 60.3%. The most common condition requiring ECMO was cardiogenic shock. Goodness-of-fit was good for APACHE IV but not the APACHE III model. The APACHE IV and APACHE III scoring systems displayed excellent areas under the receiver operating characteristic curve (0.922 ؎ 0.030 and 0.907 ؎ 0.038, respectively). Furthermore, APACHE IV correlated significantly with APACHE III scores in individual patients (r 2 ؍ 0.902; p < 0.001). Finally, cumulative survival rates at 6-month follow-up after hospital discharge differed significantly (p < 0.001 for APACHE IV <49% versus APACHE IV >49%). Conclusions. This study confirms the grave prognosis of critically ill patients receiving ECMO support. The APACHE IV proved to be a reproducible evaluation tool with excellent prognostic abilities in these patients.
Artificial Organs, 2010
Extracorporeal membrane oxygenation (ECMO) can provide short-term cardiopulmonary support to critically ill patients. Among ECMO patients, acute renal failure requiring dialysis has an ominous prognosis. However, a prognostic scoring system and risk factors adjustment for hospital mortality in these patients have not been elucidated previously. A multicenter observational cohort study was conducted from January 2002 to December 2006. Information obtained included demographics, biochemical variables, Acute Physiology and Chronic Health Evaluation (APACHE) II, III, and IV scores at ICU admission and initial acute dialysis, and hospital mortality in 102 non-coronary artery bypass graft (CABG) patients receiving ECMO support with acute dialysis. This retrospective cohort study included 70 men and 32 women with a mean age of 47.9 Ϯ 15.7 years. Seventy-two patients (70.6%) had hospital mortality. The area under the receiver operating characteristic curve showed APACHE IV (0.653) had a better discriminative power to predict hospital mortality than APACHE II (0.584) and APACHE III (0.634) at initializing dialysis. Hosmer-Lemeshow statistics showed good calibration for all three scores to predict hospital mortality at initializing dialysis (APACHE IV, P = 0.392; APACHE III, P = 0.094; and APACHE II, P = 0.673). Independent predictors for hospital mortality by multivariate logistic regression analysis were higher central venous pressure (odds ratio [OR], 1.11; confidence interval [CI] 95%, 1.02-1.20; P = 0.016), higher APACHE IV score at initializing dialysis (OR, 1.03; CI 95%, 1.01-1.05; P = 0.003), and latency from hospital admission to dialysis (OR, 1.04; CI 95%, 1.00-1.08; P = 0.033). High mortality rate was noted in non-CABG patients receiving ECMO and acute dialysis. Predialysis APACHE IV scores had good calibration and moderate discrimination in predicting hospital mortality in these patients. Because ECMO support could stabilize cardiopulmonary status, APACHE IV scores would likewise underestimate disease severity at lower score ranges in these patients.
Journal of the Formosan Medical Association, 2017
Background/Purpose: Acute kidney injury (AKI) developing during extracorporeal membrane oxygenation (ECMO) is associated with very poor outcome. The Kidney Disease: Improving Global Outcomes (KDIGO) group published a new AKI definition in 2012. This study analyzed the outcomes of patients treated with ECMO and identified the relationship between the prognosis and the KDIGO classification. Methods: This study examined total 312 patients initially, and finally reviewed the medical records of 167 patients on ECMO support at a tertiary care university hospital between March 2002 and November 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predicators. Results: The overall mortality rate was 55.7%. In the analysis of the areas under the receiver operating characteristic curves, the KDIGO classification showed relatively higher discriminatory power (0.840 AE 0.032) than the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal failure (RIFLE) (0.826 AE 0.033) and Acute Kidney Injury Network (AKIN) (0.836 AE 0.032) criteria in predicting in-hospital mortality. Furthermore, multiple logistic regression analysis showed that KDIGO, hemoglobin, and Glasgow Coma Scale score on the first day of patients on ECMO were independent predictors for in-hospital mortality. Finally, cumulative survival rates at 6-month follow-up after hospital
Predictors of Mortality in Patients Successfully Weaned from Extracorporeal Membrane Oxygenation
PLoS ONE, 2012
Purpose: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with lifethreatening respiratory failure or post-cardiotomy cardiogenic shock. This study compares the predictive value of Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Organ System Failure (OSF) obtained on the first day of ECMO removal, and the Acute Kidney Injury Network (AKIN) stages obtained at 48 hours post-ECMO removal (AKIN 48-hour) in terms of hospital mortality for critically ill patients. Methods: This study reviewed the medical records of 119 critically ill patients successfully weaned from ECMO at the specialized intensive care unit of a tertiary-care university hospital between July 2006 and October 2010. Demographic, clinical, and laboratory data were collected retrospectively as survival predictors. Results: Overall mortality rate was 26%. The most common condition requiring ECMO support was cardiogenic shock. By using the areas under the receiver operating characteristic (AUROC) curve, the Sequential Organ Failure Assessment (SOFA) score displayed good discriminative power (AUROC 0.80560.055, p,0.001). Furthermore, multiple logistic regression analysis indicated that daily urine output on the second day of ECMO removal (UO 24-48 hour), mean arterial pressure (MAP), and SOFA score on the day of ECMO removal were independent predictors of hospital mortality. Finally, cumulative survival rates at 6-month follow-up differed significantly (p,0.001) for a SOFA score#13 relative to those for a SOFA score.13. Conclusions: Following successful ECMO weaning, the SOFA score proved a reproducible evaluation tool with good prognostic abilities.
Nephrology Dialysis Transplantation, 2006
Background. Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with post-cardiotomy cardiogenic shock or life-threatening respiratory failure. Acute renal failure following ECMO support has an extremely elevated mortality rate. This study examined the outcomes of patients treated with ECMO and characterized the association between mortality and RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function and end-stage renal failure) classification. Methods. This retrospective study analysed the medical records of 46 critically ill patients-most had postcardiotomy cardiogenic shock-treated by ECMO. Sixteen patients (34.8%) were treated with both ECMO and continuous renal replacement therapies. Results. The overall mortality rate was 65.2% (30/46). A progressive and significant increase (w 2 for trend, P < 0.001) was observed for mortality based on RIFLE classification severity. The Hosmer and Lemeshow goodness-of-fit test demonstrated that the RIFLE category has a good fit. By applying the area under the receiver operating characteristic curve (AUROC), the RIFLE classification tool had good discriminative power (AUROC 0.868 AE 0.068, P < 0.001). Cumulative survival rates at 6 months follow-up following hospital discharge differed significantly (P < 0.05) for non-ARF vs RIFLE-I and RIFLE-F, and RIFLE-R vs RIFLE-F. Conclusion. This investigation confirms that the prognosis for critically ill patients supported by ECMO is grave. The RIFLE category is a simple, reproducible and easily applied evaluation tool with good prognostic capability that might generate objective information for patient families and physicians and supplements the clinical judgment of prognosis.
The Journal of surgical research, 2015
Although the use of cardiac extracorporeal membrane oxygenation (ECMO) is increasing in adult patients, the field lacks understanding of associated risk factors. While standard intensive care unit risk scores such as SAPS II (simplified acute physiology score II), SOFA (sequential organ failure assessment), and APACHE II (acute physiology and chronic health evaluation II), or disease-specific scores such as MELD (model for end-stage liver disease) and RIFLE (kidney risk, injury, failure, loss of function, ESRD) exist, they may not apply to adult cardiac ECMO patients as their risk factors differ from variables used in these scores. Between 2010 and 2014, 73 ECMOs were performed for cardiac support at our institution. Patient demographics and survival were retrospectively analyzed. A new easily calculated score for predicting ECMO mortality was created using identified risk factors from univariate and multivariate analyses, and model discrimination was compared with other scoring sys...
Use of APACHE-II as a prognostic score index for non-ICU patients with acute renal failure (ARF)
2001
In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rates. Primary or direct angioplasty has been found to be an excellent means of achieving reperfusion in acute ST-elevation MI compared to thrombolytic therapy in randomized trials. However, no mortality benefit of primary angioplasty over thrombolysis was observed in several registries, in which delays in performing primary angioplasty were longer. Our objectives were to evaluate the door-to-balloon time (DBT) in our institution and investigate its relationship with clinical and prognostic variables. We divided our patient population into two groups. Group A (GA) included patients with DBT less than 120 min and group B (GB) patients with DBT greater or equal to 120 min. We evaluated several clinical variables, such as left ventricular ejection fraction (LVEF) on their first echocardiogram during hospitalization, admission Killip classification, in-hospital length of stay (LOS) and major cardiovascular events (MACE) during hospitalization and up to 6-month follow-up (in 23 patients).