Sandrio Stany, Thiel Manfred, Krebs Joerg
Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany.
J Clin Med. 2023 Jul 24;12(14):4860. doi: 10.3390/jcm12144860.
We hypothesize that (1) a significant pre-ECMO liver impairment, which is evident in the presence of pre-ECMO acute liver injury and a higher pre-ECMO MELD (model for end-stage liver disease) score, is associated with increased mortality; and (2) the requirement of veno-veno-arterial (V-VA) ECMO support is linked to a higher prevalence of pre-ECMO acute liver injury, a higher pre-ECMO MELD score, and increased mortality. We analyze 187 ECMO runs (42 V-VA and 145 veno-venous (V-V) ECMO) between January 2017 and December 2020. The SAPS II score is calculated at ICU admission; hepatic function and MELD score are assessed at ECMO initiation (pre-ECMO) and during the first five days on ECMO. SOFA, PRESERVE and RESP scores are calculated at ECMO initiation. Pre-ECMO cardiac failure, acute liver injury, ECMO type, SAPS II and MELD, SOFA, PRESERVE, and RESP scores are associated with mortality. However, only the pre-ECMO MELD score independently predicts mortality ( = 0.04). In patients with a pre-ECMO MELD score > 16, V-VA ECMO is associated with a higher mortality risk ( = 0.0003). The requirement of V-VA ECMO is associated with the development of acute liver injury during ECMO support, a higher pre-ECMO MELD score, and increased mortality.
（1）体外膜肺氧合（ECMO）前存在明显的肝功能损害，这在ECMO前急性肝损伤和较高的ECMO前终末期肝病模型（MELD）评分中很明显，与死亡率增加相关；（2）静脉-静脉-动脉（V-VA）ECMO支持的需求与ECMO前急性肝损伤的较高患病率、较高的ECMO前MELD评分以及死亡率增加有关。我们分析了20177年7年1月至2020年12月期间的187例ECMO运行病例（42例V-VA和145例静脉-静脉（V-V）ECMO）。在重症监护病房（ICU）入院时计算序贯器官衰竭评估（SOFA）II评分；在开始ECMO时（ECMO前）和ECMO治疗的前五天评估肝功能和MELD评分。在开始ECMO时计算SOFA、器官功能障碍患者生存预测模型（PRESERVE）和呼吸（RESP）评分。ECMO前心力衰竭、急性肝损伤、ECMO类型、SOFA II和MELD、SOFA、PRESERVE和RESP评分与死亡率相关。然而，只有ECMO前MELD评分能独立预测死亡率（P = 0.04）。在ECMO前MELD评分>16的患者中，V-VA ECMO与较高的死亡风险相关（P = 0.0003）。V-VA ECMO的需求与ECMO支持期间急性肝损伤的发生、较高的ECMO前MELD评分以及死亡率增加有关。
