Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Eur J Cardiothorac Surg. 2024 Sep 2;66(3). doi: 10.1093/ejcts/ezae334.
Our goal was to determine the predictive role of the combined assessment of the vasoactive-inotropic score (VIS) and lactate levels for the prognosis of patients with postcardiotomy cardiogenic shock (PCS) requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).
The data of adult patients with PCS requiring VA-ECMO between January 2015 and December 2018 at a tertiary hospital were analysed retrospectively. The incidence of in-hospital mortality and other clinical outcomes was analysed. The associations of the VIS and the lactate concentration and in-hospital mortality were assessed using logistic regression analysis.
A total of 222 patients were included and divided into 4 groups according to the cut-off points of the VIS (24.3) and the lactate level (6.85 mmol/L). The in-hospital mortality rates were 37.7%, 50.7%, 54.8% and 76.5% for the 4 groups (P < 0.001), and the rates of successful weaning off VA-ECMO were 73.9%, 69%, 61.3% and 39.2%, respectively (P = 0.001). Groups 1 and 2 exhibited significant differences compared to group 4 in both in-hospital mortality and weaning rates (P < 0.05). There was a statistically significant difference in the incidence of multiple organ dysfunction between group 1 and group 4 (P < 0.05). Groups 1, 2 and 3 demonstrated significantly improved cumulative 30-day survival compared with group 4 (log-rank test, P < 0.05). Logistic regression analysis revealed that age, a VIS > 24.3 and lactate levels > 6.85 mmol/L were independently predictive of in-hospital mortality.
Among patients with PCS requiring VA-ECMO, the initiation before reaching a VIS > 24.3 and lactate levels > 6.85 mmol/L was associated with improved in-hospital and 30-day outcomes, suggesting that the combined assessment of the VIS and lactate levels may be instructive for determining the initiation of VA-ECMO.
本研究旨在探讨血管活性-正性肌力评分（VIS）和乳酸水平联合评估对需要体外膜肺氧合（VA-ECMO）治疗的体外循环后心源性休克（PCS）患者预后的预测作用。
回顾性分析 2015 年 1 月至 2018 年 12 月在一家三级医院接受 VA-ECMO 治疗的成人 PCS 患者的数据。分析患者院内死亡率和其他临床结局。采用 logistic 回归分析评估 VIS 和乳酸浓度与院内死亡率的相关性。
共纳入 222 例患者，根据 VIS（24.3）和乳酸水平（6.85mmol/L）的截断值将患者分为 4 组。4 组患者的院内死亡率分别为 37.7%、50.7%、54.8%和 76.5%（P<0.001），VA-ECMO 成功撤机率分别为 73.9%、69%、61.3%和 39.2%（P=0.001）。与第 4 组相比，第 1 组和第 2 组的院内死亡率和撤机率均有显著差异（P<0.05）。第 1 组和第 4 组之间的多器官功能障碍发生率存在统计学差异（P<0.05）。第 1 组、第 2 组和第 3 组与第 4 组相比，30 天累积生存率显著提高（log-rank 检验，P<0.05）。logistic 回归分析显示，年龄、VIS>24.3 和乳酸水平>6.85mmol/L 是院内死亡率的独立预测因素。
在需要 VA-ECMO 治疗的 PCS 患者中，在达到 VIS>24.3 和乳酸水平>6.85mmol/L 之前启动治疗与改善院内和 30 天结局相关，这表明联合评估 VIS 和乳酸水平可能有助于指导 VA-ECMO 的启动。
