Hao Tong, Chen Lei, Wu Changde, Xie Jianfeng, Li Chenglong, Xie Haixiu, Du Zhongtao, Liu Ling, Yang Yi, Liu Songqiao, Hou Xiaotong, Qiu Haibo
Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, People's Republic of China.
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Ann Intensive Care. 2023 Sep 27;13(1):93. doi: 10.1186/s13613-023-01186-x.
Limited data are available on renal complications in patients with acute fulminant myocarditis (AFM) receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in China. To evaluate the impact of renal complications on outcomes in adult patients with AFM supported with VA-ECMO.
Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Adult patients who were diagnosed with AFM receiving VA-ECMO support in the database were included. The primary outcome was 30-day mortality in patients with AFM supported with VA-ECMO. Logistic regression model was used to examine the impact of renal complications on 30-day mortality by adjusting confounders.
A total of 202 patients were included. The median age was 38 years (IQR 29-48) and males (n = 103) represented 51.0% of the total accounted patients. The median ECMO duration was 142.9 h (IQR 112.1-188.8 h). 178 (88.1%) patients weaned from ECMO and 156 (71.9%) patients survived. 94(46.5%) patients developed renal complications while on ECMO course. Patients with renal complications had higher 30-day mortality (40.7% (37 of 94) vs 8.3% (9 of 108), P < 0.001) compared with those without. The development of renal complications was related to a 3.12-fold increase risk of 30-day mortality (adjusted OR 3.120, 95%CI 1.002-6.577, P = 0.049). Increasing age (adjusted OR1.025, 95% CI 1.008-1.298, P = 0.040) and higher SOFA score (adjusted OR 1.162, 95%CI 1.012-1.334, P = 0.034) were independent risk factors of renal complications.
Our findings demonstrated that patients with AFM receiving VA-ECMO at high risk of developing renal complications. Advancing age and higher SOFA score was associated with increased risk of developing renal complications. The onset of renal complications was significantly associated with 30-day mortality.
在中国，关于接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的急性暴发性心肌炎（AFM）患者肾脏并发症的数据有限。本研究旨在评估肾脏并发症对接受VA-ECMO支持的成年AFM患者预后的影响。
数据来自中国体外生命支持学会（CSECLS）注册数据库。纳入数据库中诊断为AFM并接受VA-ECMO支持的成年患者。主要结局是接受VA-ECMO支持的AFM患者的30天死亡率。采用逻辑回归模型，通过调整混杂因素来检验肾脏并发症对30天死亡率的影响。
共纳入202例患者。中位年龄为38岁（四分位间距29 - 48岁），男性（n = 103）占总纳入患者的51.0%。ECMO中位持续时间为142.9小时（四分位间距112.1 - 188.8小时）。178例（88.1%）患者成功撤离ECMO，156例（71.9%）患者存活。94例（46.5%）患者在ECMO治疗过程中出现肾脏并发症。与未出现肾脏并发症的患者相比，出现肾脏并发症的患者30天死亡率更高（40.7%（94例中的37例）对8.3%（108例中的9例），P < 0.001）。肾脏并发症的发生与30天死亡率增加3.12倍相关（调整后的比值比3.120，95%置信区间1.002 - 6.577，P = 0.049）。年龄增加（调整后的比值比1.025，95%置信区间1.008 - 1.298）和较高的序贯器官衰竭评估（SOFA）评分（调整后的比值比1.162，95%置信区间1.012 - 1.334）是肾脏并发症的独立危险因素。
我们的研究结果表明，接受VA-ECMO的AFM患者发生肾脏并发症的风险较高。年龄增长和较高的SOFA评分与发生肾脏并发症的风险增加相关。肾脏并发症的发生与30天死亡率显著相关。
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