Lazzeri Chiara, Bonizzoli Manuela, Cianchi Giovanni, Batacchi Stefano, Chiostri Marco, Fulceri Giorgio Enzo, Buoninsegni Laura Tadini, Peris Adriano
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
J Artif Organs. 2018 Mar;21(1):61-67. doi: 10.1007/s10047-017-0979-0. Epub 2017 Aug 18.
Bilirubin is known as a marker of hepatic dysfunction and is incorporated in scoring algorithms to assess prognosis in critically ill patients. No data are so far available on the prognostic role of hepatic dysfunction in patients with severe ARDS on venovenous extracorporeal membrane oxygenation (VV-ECMO) support. In 112 consecutive patients with severe ARDS treated with VV-ECMO, we aimed at assessing whether increased bilirubin during the first 72 h could affect early death. Increased serum bilirubin (≥1.2 mg/dl) was detectable in 29 patients (25.9%) who were older (p = 0.031), exhibited a higher SOFA score (p = 0.006), were more frequently given pre-ECMO muscular blockers (p = 0.001) and supported with ECMO for a longer period (p = 0.024), when compared to patients with normal bilirubin. No difference in in-ICU mortality rate was observed between the two subgroups. In survivors, bilirubin showed a progressive and significant decrease (p = 0.032) during the first 72 h of ECMO support, while it increased in dead patients (p = 0.007).The mortality rate was higher in patients with increased bilirubin at 24, 48 and 72 h after ECMO start in respect to that of patients with normal values. Pre-ECMO increased bilirubin values (≥1.2 mg/dl), being detectable in about one-fourth of the entire population, is not associated with increased in-ICU mortality, while the persistence of increased bilirubin values after 24 h of ECMO start and within the first 3 days identified a subgroup of patients at higher risk of death.
胆红素被认为是肝功能障碍的标志物，并被纳入评分算法以评估危重症患者的预后。目前尚无关于肝功能障碍在接受静脉-静脉体外膜肺氧合（VV-ECMO）支持的重症急性呼吸窘迫综合征（ARDS）患者中的预后作用的数据。在112例接受VV-ECMO治疗的重症ARDS连续患者中，我们旨在评估最初72小时内胆红素升高是否会影响早期死亡。29例患者（25.9%）可检测到血清胆红素升高（≥1.2mg/dl），与胆红素正常的患者相比，这些患者年龄更大（p=0.031）、序贯器官衰竭评估（SOFA）评分更高（p=0.006）、更频繁地在ECMO前使用肌肉阻滞剂（p=0.001）且接受ECMO支持的时间更长（p=0.024）。两个亚组之间的重症监护病房（ICU）死亡率无差异。在幸存者中，胆红素在ECMO支持的最初72小时内呈逐渐且显著下降（p=0.032），而在死亡患者中则升高（p=0.007）。与胆红素正常的患者相比，在ECMO开始后24、48和72小时胆红素升高的患者死亡率更高。ECMO前胆红素值升高（≥1.2mg/dl）在整个人口中约四分之一可检测到，与ICU死亡率增加无关，而在ECMO开始24小时后且在最初3天内胆红素值持续升高则确定了一组死亡风险较高的患者亚组。
