Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary.
Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
Int J Artif Organs. 2020 Oct;43(10):684-691. doi: 10.1177/0391398820906538. Epub 2020 Feb 25.
Veno-arterial extracorporeal membrane oxygenation is a valuable therapeutic approach in patients with severe heart failure due to different etiologies. Current prognosis with veno-arterial extracorporeal membrane oxygenation is unsatisfactory, and the risk stratification is still challenging. Therefore, we aimed to evaluate the predictive value of different baseline model for end-stage liver disease scores for survival in patients with veno-arterial extracorporeal membrane oxygenation.
We conducted an observational, retrospective study of consecutive veno-arterial extracorporeal membrane oxygenation-treated patients between January 2012 and August 2018. The four types of model for end-stage liver disease scores-model for end-stage liver disease, international normalized ratio-excluded model for end-stage liver disease, modified model for end-stage liver disease, and model for end-stage liver disease with sodium-were calculated preoperatively. Veno-arterial extracorporeal membrane oxygenation was used based on the four clinical indications: primer graft failure after heart transplantation, weaning failure from cardiopulmonary bypass, acute myocardial infarction with refractory cardiogenic shock, and bridge to transplantation or bridge to candidacy. The primary endpoint of the study was overall mortality. The secondary endpoint was in-hospital mortality. We performed univariable and multivariable Cox regression analyses.
Data from 135 patients were analyzed. The median follow-up was 952 days (interquartile range = 417-1555 days). In-hospital mortality was 62.2%, and overall mortality was 71.1%. The multivariable Cox regression analysis is adjusted for indication, and the survival after veno-arterial extracorporeal membrane oxygenation score showed that the following scores were associated with overall mortality: model for end-stage liver disease (hazard ratio = 1.04; 95% confidence interval = 1.01-1.07; = 0.016), modified model for end-stage liver disease (hazard ratio = 1.04; 95% confidence interval = 1.01-1.06; = 0.006), and model for end-stage liver disease with sodium (hazard ratio = 1.05; 95% confidence interval = 1.02-1.08; = 0.001).
Model for end-stage liver disease, modified model for end-stage liver disease, and model for end-stage liver disease with sodium scores could be useful in the risk stratification of veno-arterial extracorporeal membrane oxygenation treatment in varying clinical indications.
在因不同病因导致严重心力衰竭的患者中，静脉-动脉体外膜肺氧合是一种有价值的治疗方法。目前静脉-动脉体外膜肺氧合的预后并不理想，风险分层仍然具有挑战性。因此，我们旨在评估不同基线终末期肝病模型评分对静脉-动脉体外膜肺氧合患者生存的预测价值。
我们对 2012 年 1 月至 2018 年 8 月间连续接受静脉-动脉体外膜肺氧合治疗的患者进行了一项观察性、回顾性研究。在术前计算了终末期肝病模型、国际标准化比值排除的终末期肝病模型、改良终末期肝病模型和终末期肝病钠模型这四种终末期肝病模型评分。静脉-动脉体外膜肺氧合的使用基于四种临床适应证：心脏移植后原发移植物失功、心肺转流脱机失败、急性心肌梗死后难治性心源性休克以及移植或候选桥接。本研究的主要终点为总死亡率。次要终点为住院死亡率。我们进行了单变量和多变量 Cox 回归分析。
对 135 名患者的数据进行了分析。中位随访时间为 952 天（四分位距 417-1555 天）。住院死亡率为 62.2%，总死亡率为 71.1%。多变量 Cox 回归分析调整了适应证，静脉-动脉体外膜肺氧合评分后的生存分析表明，以下评分与总死亡率相关：终末期肝病模型（风险比 1.04；95%置信区间 1.01-1.07；P=0.016）、改良终末期肝病模型（风险比 1.04；95%置信区间 1.01-1.06；P=0.006）和终末期肝病钠模型（风险比 1.05；95%置信区间 1.02-1.08；P=0.001）。
终末期肝病模型、改良终末期肝病模型和终末期肝病钠模型评分可用于不同临床适应证下静脉-动脉体外膜肺氧合治疗的风险分层。
