Alexander Erin, O'Sullivan Donnchadh, Aganga Devon, Hassan Sara, Ibrahim Samar H, Absah Imad
Division of Pediatric Gastroenterology & Hepatology.
Department of Pediatric and Adolescent Medicine.
J Pediatr Gastroenterol Nutr. 2022 Mar 1;74(3):333-337. doi: 10.1097/MPG.0000000000003364.
Extracorporeal membrane oxygenation (ECMO)-associated direct hyperbilirubinemia (DHB) is likely multifactorial. The objective of this study is to assess the frequency and risk factors for developing direct hyperbilirubinemia while on ECMO, and its implication on the mortality of children.
We performed a retrospective study between January 2010 and January 2020. Using Mayo Clinic electronic health record, we identified children (<18 years) who required veno-arterial (VA) ECMO support. Demographics, ECMO indication, laboratory findings, and outcomes were abstracted. Illness acuity scores, including vasoactive-ionotropic score (VIS), were used to assess disease severity at time of admission. Study cohort was divided into two groups: children who developed direct hyperbilirubinemia (DHB) on ECMO and children who did not (control). DHB was defined as direct bilirubin (DB) of >1.0 mg/dL. Disease acuity and mortality rates were compared between the two groups. Logistic regression was used to analyze the risk of mortality independent of potential confounding variables.
We identified 106 children who required ECMO support during the study period. Of those, 36 (34%) children developed DHB on ECMO. Illness acuity scores were significantly higher in the DHB group on ECMO day 2 (P = 0.046) and day 7 (P = 0.01). Mortality rate was higher in the DHB group 72%, versus 29% in the control group (P < 0.001).
DHB was associated with a higher mortality rate than the control group.
体外膜肺氧合（ECMO）相关的直接胆红素血症（DHB）可能是多因素导致的。本研究的目的是评估在接受ECMO治疗期间发生直接胆红素血症的频率和危险因素，及其对儿童死亡率的影响。
我们在2010年1月至2020年1月期间进行了一项回顾性研究。利用梅奥诊所的电子健康记录，我们确定了需要静脉-动脉（VA）ECMO支持的儿童（<18岁）。提取了人口统计学、ECMO适应症、实验室检查结果和结局。使用疾病严重程度评分，包括血管活性-正性肌力评分（VIS），来评估入院时的疾病严重程度。研究队列分为两组：在ECMO上发生直接胆红素血症（DHB）的儿童和未发生的儿童（对照组）。DHB定义为直接胆红素（DB）>1.0mg/dL。比较两组之间的疾病严重程度和死亡率。使用逻辑回归分析独立于潜在混杂变量的死亡风险。
我们确定了106名在研究期间需要ECMO支持的儿童。其中，36名（34%）儿童在ECMO上发生了DHB。在ECMO第2天（P = 0.046）和第7天（P = 0.01），DHB组的疾病严重程度评分显著更高。DHB组的死亡率更高，为72%，而对照组为29%（P < 0.001）。
与对照组相比，DHB与更高的死亡率相关。
