Jenq Chang-Chyi, Tsai Feng-Chun, Tsai Tsung-Yu, Hsieh Sue-Yun, Lai Yi-Wen, Tian Ya-Chung, Chang Ming-Yang, Lin Chan-Yu, Fang Ji-Tseng, Yang Chih-Wei, Chen Yung-Chang
Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.
School of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan.
Artif Organs. 2018 Jul;42(7):705-713. doi: 10.1111/aor.13123. Epub 2018 Mar 30.
Anemia is a component of the pathological triangle in cardiorenal anemia syndrome and is a risk factor for mortality in acute respiratory distress syndrome. This study assessed the predictive value of anemia for outcomes in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) support. This retrospective study analyzed patients who received ECMO support at the cardiovascular surgery intensive care unit in the study institute between July 2003 and March 2012. Patient data, such as demographic information, etiologies of ECMO implementation, clinical parameters, and in-hospital and 6-month mortality rates, were statistically analyzed. The overall in-hospital mortality rate among the enrolled 295 patients was 55.6%. Multivariate logistical regression analysis indicated that age, albumin levels, sequential organ failure assessment (SOFA) score, and hemoglobin (Hb) level on ECMO day 1 exhibited independent prognostic significance for predicting in-hospital mortality rate. The SOFA score exhibited the highest areas under the receiver operating characteristic curve value (0.812 ± 0.025). The Hb level on ECMO day 1 exhibited satisfactory calibration and discriminatory power. The cumulative 6-month survival rates differed significantly between patients with Hb levels less than and more than 8.85 g/dL (30.6 vs. 54.0%, respectively, P < 0.001). This study indicated that old age, low albumin levels, low Hb levels, and higher SOFA scores on ECMO day 1 increased the risk of mortality. The Hb level is a readily measurable parameter and with good predictive power for critical patients on ECMO.
贫血是心肾贫血综合征病理三角的一个组成部分，也是急性呼吸窘迫综合征患者死亡的危险因素。本研究评估了贫血对接受体外膜肺氧合（ECMO）支持的危重症患者预后的预测价值。这项回顾性研究分析了2003年7月至2012年3月在研究机构心血管外科重症监护病房接受ECMO支持的患者。对患者数据进行了统计分析，包括人口统计学信息、ECMO实施的病因、临床参数以及住院和6个月死亡率。在纳入的295例患者中，总体住院死亡率为55.6%。多因素logistic回归分析表明，年龄、白蛋白水平、序贯器官衰竭评估（SOFA）评分以及ECMO第1天的血红蛋白（Hb）水平对预测住院死亡率具有独立的预后意义。SOFA评分在受试者工作特征曲线下面积值最高（0.812±0.025）。ECMO第1天的Hb水平具有良好的校准和鉴别能力。Hb水平低于和高于8.85 g/dL的患者6个月累积生存率差异显著（分别为30.6%和54.0%，P<0.001）。本研究表明，高龄、低白蛋白水平、低Hb水平以及ECMO第1天较高的SOFA评分会增加死亡风险。Hb水平是一个易于测量的参数，对接受ECMO的危重症患者具有良好的预测能力。
