Assistance Publique des Hopitaux de Paris, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
Assistance Publique des Hopitaux de Paris, Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, Paris Diderot University, Sorbonne Paris Cité, INSERM/Paris Diderot University, Paris, France.
Intensive Care Med. 2024 Mar;50(3):406-417. doi: 10.1007/s00134-024-07354-2. Epub 2024 Mar 4.
The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are seldom documented, making ECMO candidacy decisions challenging. This study aims (1) to report outcomes of immunocompromised patients treated with VA-ECMO, (2) to identify pre-ECMO predictors of 90-day mortality, (3) to assess the impact of immunodepression on 90-day mortality, and (4) to describe the main ECMO-related complications.
This is a retrospective, propensity-weighted study conducted in two French experienced ECMO centers.
From January 2006 to January 2022, 177 critically ill immunocompromised patients (median (interquartile range, IQR) age 49 (32-60) years) received VA-ECMO. The main causes of immunosuppression were long-term corticosteroids/immunosuppressant treatment (29%), hematological malignancy (26%), solid organ transplant (20%), and solid tumor (13%). Overall 90-day and 1-year mortality were 70% (95% confidence interval (CI) 63-77%) and 75% (95% CI 65-79%), respectively. Older age and higher pre-ECMO lactate were independently associated with 90-day mortality. Across immunodepression causes, 1-year mortality ranged from 58% for patients with infection by human immunodeficiency virus (HIV) or asplenia, to 89% for solid organ transplant recipients. Hemorrhagic and infectious complications affected 39% and 54% of patients, while more than half the stay in intensive care unit (ICU) was spent on antibiotics. In a propensity score-weighted model comparing the 177 patients with 942 non-immunocompromised patients experiencing cardiogenic shock on VA-ECMO, immunocompromised status was independently associated with a higher 90-day mortality (odds ratio 2.53, 95% CI 1.72-3.79).
Immunocompromised patients undergoing VA-ECMO treatment face an unfavorable prognosis, with higher 90-day mortality compared to non-immunocompromised patients. This underscores the necessity for thorough evaluation and careful selection of ECMO candidates within this frail population.
免疫功能低下的心源性休克患者接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的结果很少有记录，这使得 ECMO 候选者的决策具有挑战性。本研究旨在：（1）报告接受 VA-ECMO 治疗的免疫功能低下患者的结果；（2）确定 ECMO 前预测 90 天死亡率的因素；（3）评估免疫抑制对 90 天死亡率的影响；（4）描述主要的 ECMO 相关并发症。
这是一项在法国两家有经验的 ECMO 中心进行的回顾性、倾向评分加权研究。
从 2006 年 1 月至 2022 年 1 月，177 例重症免疫功能低下患者（中位（四分位距，IQR）年龄 49（32-60）岁）接受了 VA-ECMO 治疗。免疫抑制的主要原因是长期皮质激素/免疫抑制剂治疗（29%）、血液系统恶性肿瘤（26%）、实体器官移植（20%）和实体肿瘤（13%）。总体 90 天和 1 年死亡率分别为 70%（95%置信区间（CI）63-77%）和 75%（95% CI 65-79%）。年龄较大和较高的 ECMO 前乳酸水平与 90 天死亡率独立相关。在免疫抑制原因方面，1 年死亡率范围从感染人类免疫缺陷病毒（HIV）或脾切除的患者的 58%，到实体器官移植受者的 89%。出血和感染并发症影响了 39%和 54%的患者，而 ICU 住院时间的一半以上用于使用抗生素。在一个比较 177 例接受 VA-ECMO 治疗的心源性休克的免疫功能低下患者和 942 例非免疫功能低下患者的倾向评分加权模型中，免疫功能低下状态与较高的 90 天死亡率独立相关（比值比 2.53，95% CI 1.72-3.79）。
接受 VA-ECMO 治疗的免疫功能低下患者预后不佳，与非免疫功能低下患者相比，90 天死亡率更高。这强调了在这个脆弱人群中，需要对 ECMO 候选者进行全面评估和仔细选择。
