Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Ren Fail. 2023;45(2):2282019. doi: 10.1080/0886022X.2023.2282019. Epub 2023 Nov 20.
In patients receiving extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT) is increasingly being used for renal replacement and fluid management. However, critically ill surgical patients receiving combined ECMO and CRRT tend to have a high mortality rate, and there are limited studies on this population. Therefore, we aimed to investigate the risk factors for mortality in surgical patients receiving combined ECMO and CRRT.
Data of surgical patients who underwent ECMO between December 2013 and April 2023 were retrospectively reviewed. Univariate and multivariate logistic regression analysis were used to identify the risk variables. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff value of albumin and age to predict death.
A total of 199 patients on ECMO support were screened, of which 105 patients were included in the final analysis. Of 105 patients, 77 (73.33%) were treated with CRRT. Veno-arterial ECMO was performed in 97 cases (92.38%), and the rest were veno-venous ECMO ( = 8, 7.62%). Cardiovascular-related surgery was performed in the main patients ( = 86, 81.90%) and other types of surgery in 19 patients. In surgical patients on ECMO support, the logistic regression analysis showed that CRRT implantation, male sex, and age were the independent risks factors for mortality. Furthermore, the ROC curve analysis showed that age 48.5 years had the highest Youden index. In surgical patients on combined CRRT and ECMO, age, valvular heart disease, and albumin were the independent risk factors for prognosis. Albumin had the highest Youden index at a cutoff value of 39.95 g/L for predicting mortality, though the overall predictive value was modest (area under ROC 0.704). Age had the highest Youden index at a cutoff value of 48.5 years for predicting mortality.
In our cohort of surgical patients requiring ECMO, which consisted mostly of patients undergoing cardiovascular surgery requiring VA-ECMO, the need for CRRT was an independent risk factor for mortality. In the subset of patients on combined CRRT and ECMO, independent risk factors for mortality included higher age, lack of valvular heart disease, and lower serum albumin.
在接受体外膜肺氧合（ECMO）治疗的患者中，连续肾脏替代疗法（CRRT）越来越多地用于肾脏替代和液体管理。然而，接受 ECMO 和 CRRT 联合治疗的危重症外科患者死亡率较高，对此人群的研究有限。因此，我们旨在探讨接受 ECMO 和 CRRT 联合治疗的外科患者死亡的危险因素。
回顾性分析 2013 年 12 月至 2023 年 4 月期间接受 ECMO 治疗的外科患者的数据。使用单因素和多因素逻辑回归分析确定风险变量。使用受试者工作特征（ROC）曲线分析确定白蛋白和年龄的截断值以预测死亡。
共筛选出 199 例接受 ECMO 支持的患者，其中 105 例纳入最终分析。在 105 例患者中，77 例（73.33%）接受了 CRRT 治疗。97 例（92.38%）行静脉-动脉 ECMO，其余为静脉-静脉 ECMO（ = 8，7.62%）。主要患者行心血管相关手术（ = 86，81.90%），19 例患者行其他类型手术。在接受 ECMO 支持的外科患者中，逻辑回归分析显示，CRRT 植入、男性和年龄是死亡的独立危险因素。此外，ROC 曲线分析显示年龄 48.5 岁时具有最高的约登指数。在接受联合 CRRT 和 ECMO 治疗的外科患者中，年龄、瓣膜性心脏病和白蛋白是预后的独立危险因素。白蛋白的截断值为 39.95 g/L 时，预测死亡率的约登指数最高，但整体预测值中等（ROC 曲线下面积 0.704）。年龄的截断值为 48.5 岁时，预测死亡率的约登指数最高。
在我们的 ECMO 治疗外科患者队列中，大多数患者接受心血管手术需要 VA-ECMO，需要 CRRT 是死亡的独立危险因素。在接受联合 CRRT 和 ECMO 治疗的患者亚组中，死亡的独立危险因素包括年龄较高、无瓣膜性心脏病和血清白蛋白较低。
