Jang Jin Ho, Shin Kyung-Hwa, Lee Hye Rin, Son Eunjeong, Lee Seung Eun, Seol Hee Yun, Yoon Seong Hoon, Kim Taehwa, Cho Woo Hyun, Jeon Doosoo, Kim Yun Seong, Yeo Hye Ju
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea.
Transplantation Research Center and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea.
J Clin Med. 2023 Jul 6;12(13):4520. doi: 10.3390/jcm12134520.
Studies on inflammatory markers, endothelial activation, and bleeding during extracorporeal membrane oxygenation (ECMO) are lacking. Blood samples were prospectively collected after ECMO initiation from 150 adult patients who underwent ECMO for respiratory failure between 2018 and 2021. After excluding patients who died early (within 48 h), 132 patients were finally included. Their tumor necrosis factor-alpha (TNF-α), tissue factor (TF), soluble thrombomodulin (sTM), and E-selectin levels were measured. A Cox proportional hazards regression model was used to estimate the hazard ratio for hemorrhagic complications during ECMO. The 132 patients were divided into hemorrhagic ( = 23, H group) and non-complication ( = 109, N group) groups. The sequential organ failure assessment score, hemoglobin level, and ECMO type were included as covariates in all Cox models to exclude the effects of clinical factors. After adjusting for these factors, initial TNF-α, TF, sTM, E-selectin, and activated protein C levels were significantly associated with hemorrhagic complications (all < 0.001). TNF-α, TF, and E-selectin better predicted hemorrhagic complications than the model that included only the aforementioned clinical factors (clinical factors only (area under the curve [AUC]: 0.804), reference; TNF-α (AUC: 0.914); TF (AUC: 0.915); E-selectin (AUC: 0.869)). Conclusions: TNF-α levels were significantly predictive of hemorrhagic complications during ECMO.
关于体外膜肺氧合（ECMO）期间炎症标志物、内皮激活和出血的研究尚缺。在2018年至2021年期间，对150例因呼吸衰竭接受ECMO治疗的成年患者在启动ECMO后进行前瞻性血样采集。排除早期死亡（48小时内）的患者后，最终纳入132例患者。检测其肿瘤坏死因子-α（TNF-α）、组织因子（TF）、可溶性血栓调节蛋白（sTM）和E选择素水平。采用Cox比例风险回归模型估计ECMO期间出血并发症的风险比。将132例患者分为出血组（n = 23，H组）和无并发症组（n = 109，N组）。在所有Cox模型中纳入序贯器官衰竭评估评分、血红蛋白水平和ECMO类型作为协变量，以排除临床因素的影响。校正这些因素后，初始TNF-α、TF、sTM、E选择素和活化蛋白C水平与出血并发症显著相关（均P < 0.001）。与仅包含上述临床因素的模型相比，TNF-α、TF和E选择素能更好地预测出血并发症（仅临床因素（曲线下面积[AUC]：0.804），作为对照；TNF-α（AUC：0.914）；TF（AUC：0.915）；E选择素（AUC：0.869））。结论：TNF-α水平可显著预测ECMO期间的出血并发症。
