预测接受体外膜氧合治疗的终末期肾病患者的住院死亡率

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiorenal Medicine Pub Date : 2025-01-01 Epub Date: 2025-01-08 DOI:10.1159/000543434
Tsung-Yu Tsai, Pei-Chun Fan, Cheng-Chia Lee, Shao-Wei Chen, Jia-Jin Chen, Ming-Jen Chan, Ji-Tseng Fang, Yung-Chang Chen, Chih-Hsiang Chang
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引用次数: 0

摘要

导读:随着肾损伤严重程度的增加,接受体外膜氧合(ECMO)治疗的患者往往会经历更糟糕的肾脏结局和更高的死亡率。然而,终末期肾病(ESRD)患者的住院死亡率风险尚不清楚。本研究评估了与接受ECMO治疗的ESRD患者住院死亡率相关的几个预后因素。方法:回顾2009年3月至2022年2月在林口市长庚纪念医院重症监护室接受静脉动脉ECMO治疗的90例成年ESRD患者的病历。14例接受ECMO支持后24小时内死亡的患者被排除在外;其余76名患者纳入研究。回顾性收集人口学、临床和实验室变量作为生存预测因子。主要终点是住院死亡率。结果:住院总死亡率为69.7%。最常见的需要ECMO支持的诊断是心切术后心源性休克,最常见的ECMO相关并发症是感染。多元logistic回归分析显示,ECMO支持第1天的急性生理和慢性健康评估II (APACHE II)评分是院内死亡的独立危险因素。APACHE II评分在受试者工作特征曲线下的判别能力为0.788±0.057。APACHE II评分≤29分的患者与APACHE II评分为> 29分的患者6个月随访时的累积生存率差异显著(P < 0.001)。结论:对于ECMO的ESRD患者,APACHE II评分是院内死亡率的一个很好的预测指标。
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Predicting In-Hospital Mortality in Patients with End-Stage Renal Disease Receiving Extracorporeal Membrane Oxygenation Therapy.

Introduction: Patients on extracorporeal membrane oxygenation (ECMO) often experience worse renal outcomes and higher mortality rates as the severity of kidney injury increases. Nevertheless, the in-hospital mortality risks of patients with end-stage renal disease (ESRD) are poorly understood. This study evaluated several prognostic factors associated with in-hospital mortality in patients with ESRD receiving ECMO therapy.

Methods: This study reviewed the medical records of 90 adult patients with ESRD on venoarterial ECMO in intensive care units in Linkou Chang Gung Memorial Hospital between March 2009 and February 2022. Fourteen patients who died within 24 h of receiving ECMO support were excluded; the remaining 76 patients were enrolled. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. The primary outcome was in-hospital mortality.

Results: The overall in-hospital mortality rate was 69.7%. The most common diagnosis requiring ECMO support was postcardiotomy cardiogenic shock, and the most frequent ECMO-associated complication was infection. Multiple logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on day 1 of ECMO support was an independent risk factor for in-hospital mortality. The APACHE II score demonstrated satisfactory discriminative power (0.788 ± 0.057) in the area under the receiver operating characteristic curve. The cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) between patients with APACHE II score ≤ 29 versus those with APACHE II score >29.

Conclusion: For patients with ESRD on ECMO, the APACHE II score is an excellent predictor of in-hospital mortality.

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来源期刊
Cardiorenal Medicine
Cardiorenal Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-UROLOGY & NEPHROLOGY
CiteScore
5.40
自引率
2.60%
发文量
25
审稿时长
>12 weeks
期刊介绍: The journal ''Cardiorenal Medicine'' explores the mechanisms by which obesity and other metabolic abnormalities promote the pathogenesis and progression of heart and kidney disease (cardiorenal metabolic syndrome). It provides an interdisciplinary platform for the advancement of research and clinical practice, focussing on translational issues.
期刊最新文献
Advances in Cardiorenal Medicine; the Year 2024 in Review. Biomarkers for Predicting of Sepsis-Induced Cardiorenal Syndrome in Emergency Settings. Immunosuppressive therapy-related cardiovascular risk factors in renal transplantation: a narrative review. HepatoCardioRenal Syndrome: Integrating Pathophysiology with Clinical Decision-Making via POCUS. A New Era in the Management of Cardiorenal Syndrome: The Importance of Cardiorenal Units.
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