Bunte Sebastian, Walz Roland, Merkel Julia, Torregroza Carolin, Roth Sebastian, Lurati Buse Giovanna, Dalyanoglu Hannan, Akhyari Payam, Lichtenberg Artur, Hollmann Markus W, Aubin Hug, Huhn Ragnar
Department of Anesthesiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
J Clin Med. 2020 Jun 3;9(6):1727. doi: 10.3390/jcm9061727.
Extracorporeal life support (ECLS) is a promising therapeutic option for patients with refractory cardiogenic shock. However, as the mortality rate still remains high, there is a need for early outcome parameters reflecting therapy success or futility. Therefore, we investigated whether liver enzyme levels could serve as prognostic mortality markers for patients with ECLS. The present study is a retrospective single-center cohort study. Adult patients >18 years of age who received ECLS therapy between 2011 and 2018 were included. Bilirubin, glutamic-oxaloacetic transaminase (GOT), and glutamic-pyruvic-transaminase (GPT) serum levels were analyzed at day 5 after the start of the ECLS therapy. The primary endpoint of this study was all-cause in-hospital mortality. A total of 438 patients received ECLS during the observation period. Based on the inclusion criteria, 298 patients were selected for the statistical analysis. The overall mortality rate was 42.6% ( = 127). The area under the curve (AUC) in the receiver operating characteristic curve (ROC) for bilirubin on day 5 was 0.72 (95% confidence interval (CI): 0.66-0.78). Cox regression with multivariable adjustment revealed a significant association between bilirubin on day 5 and mortality, with a hazard ratio (HR) of 2.24 (95% CI: 1.53-3.30). Based on the results of this study, an increase in serum bilirubin on day 5 of ECLS therapy correlates independently with mortality.
体外生命支持（ECLS）是治疗难治性心源性休克患者的一种有前景的治疗选择。然而，由于死亡率仍然很高，需要有反映治疗成功或无效的早期预后参数。因此，我们研究了肝酶水平是否可作为接受ECLS治疗患者的预后死亡标志物。本研究是一项回顾性单中心队列研究。纳入2011年至2018年间接受ECLS治疗的18岁以上成年患者。在ECLS治疗开始后第5天分析胆红素、谷草转氨酶（GOT）和谷丙转氨酶（GPT）的血清水平。本研究的主要终点是全因院内死亡率。在观察期内共有438例患者接受了ECLS治疗。根据纳入标准，选择298例患者进行统计分析。总死亡率为42.6%（n = 127）。第5天胆红素的受试者工作特征曲线（ROC）下面积（AUC）为0.72（95%置信区间（CI）：0.66 - 0.78）。多变量调整的Cox回归显示第5天胆红素与死亡率之间存在显著关联，风险比（HR）为2.24（95%CI：1.53 - 3.30）。基于本研究结果，ECLS治疗第5天血清胆红素升高与死亡率独立相关。
