Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Departments of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Lung. 2023 Aug;201(4):397-406. doi: 10.1007/s00408-023-00630-w. Epub 2023 Jul 4.
Hemorrhagic stroke (HS) is a devastating complication during extracorporeal membrane oxygenation (ECMO) but markers of risk stratification during COVID-19 are unknown. Lactate dehydrogenase (LDH) is a readily available biomarker of cell injury and permeability. We sought to determine whether an elevated LDH before ECMO placement is related to the occurrence of HS during ECMO for COVID-19.
Adult patients with COVID-19 requiring ECMO between March 2020 and February 2022 were included. LDH values prior to ECMO placement were captured. Patients were categorized into high (> 750 U/L) or low (≤ 750 U/L) LDH groups. Multivariable regression modeling was used to determine the association between LDH and HS during ECMO.
There were 520 patients that underwent ECMO placement in 17 centers and 384 had an available LDH. Of whom, 122 (32%) had a high LDH. The overall incidence of HS was 10.9%, and patients with high LDH had a higher incidence of HS than those with low LDH level (17% vs 8%, p = 0.007). At 100 days, the probability of a HS was 40% in the high LDH group and 23% in those with a low LDH, p = 0.002. After adjustment for clinical covariates, high LDH remained associated with subsequent HS (aHR: 2.64, 95% CI 1.39-4.92). Findings were similar when restricting to patients supported by venovenous ECMO only.
Elevated LDH prior to ECMO cannulation is associated with a higher incidence of HS during device support. LDH can risk stratify cases for impending cerebral bleeding during ECMO.
体外膜肺氧合（ECMO）期间发生脑出血（HS）是一种破坏性的并发症，但 COVID-19 期间的风险分层标志物尚不清楚。乳酸脱氢酶（LDH）是细胞损伤和通透性的一种易于获得的生物标志物。我们旨在确定 ECMO 前 LDH 升高是否与 COVID-19 患者 ECMO 期间发生 HS 有关。
纳入 2020 年 3 月至 2022 年 2 月期间需要 ECMO 的 COVID-19 成年患者。记录 ECMO 前的 LDH 值。将患者分为高（>750 U/L）或低（≤750 U/L）LDH 组。多变量回归模型用于确定 ECMO 期间 LDH 与 HS 之间的关联。
17 个中心共 520 例患者行 ECMO 治疗，其中 384 例有可用的 LDH 值。其中，122 例（32%）LDH 升高。HS 的总发生率为 10.9%，LDH 升高的患者 HS 发生率高于 LDH 水平较低的患者（17% vs 8%，p=0.007）。在 100 天，高 LDH 组 HS 的概率为 40%，而 LDH 水平较低的患者为 23%，p=0.002。在调整临床协变量后，高 LDH 与随后发生 HS 相关（调整后的 HR：2.64，95%CI 1.39-4.92）。仅限制为接受静脉-静脉 ECMO 支持的患者时，发现结果相似。
ECMO 插管前 LDH 升高与 ECMO 支持期间 HS 发生率升高相关。LDH 可以对 ECMO 期间即将发生的脑溢血风险进行分层。
