Tsai Tsung-Yu, Fan Pei-Chun, Lee Cheng-Chia, Chen Shao-Wei, Chen Jia-Jin, Chan Ming-Jen, Fang Ji-Tseng, Chen Yung-Chang, Chang Chih-Hsiang
Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Cardiorenal Med. 2025;15(1):164-173. doi: 10.1159/000543434. Epub 2025 Jan 8.
Patients on extracorporeal membrane oxygenation (ECMO) often experience worse renal outcomes and higher mortality rates as the severity of kidney injury increases. Nevertheless, the in-hospital mortality risks of patients with end-stage renal disease (ESRD) are poorly understood. This study evaluated several prognostic factors associated with in-hospital mortality in patients with ESRD receiving ECMO therapy.
This study reviewed the medical records of 90 adult patients with ESRD on venoarterial ECMO in intensive care units in Linkou Chang Gung Memorial Hospital between March 2009 and February 2022. Fourteen patients who died within 24 h of receiving ECMO support were excluded; the remaining 76 patients were enrolled. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. The primary outcome was in-hospital mortality.
The overall in-hospital mortality rate was 69.7%. The most common diagnosis requiring ECMO support was postcardiotomy cardiogenic shock, and the most frequent ECMO-associated complication was infection. Multiple logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on day 1 of ECMO support was an independent risk factor for in-hospital mortality. The APACHE II score demonstrated satisfactory discriminative power (0.788 ± 0.057) in the area under the receiver operating characteristic curve. The cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) between patients with APACHE II score ≤ 29 versus those with APACHE II score >29.
For patients with ESRD on ECMO, the APACHE II score is an excellent predictor of in-hospital mortality.
随着肾损伤严重程度的增加，接受体外膜肺氧合（ECMO）治疗的患者往往会出现更差的肾脏预后和更高的死亡率。然而，终末期肾病（ESRD）患者的院内死亡风险尚不清楚。本研究评估了接受ECMO治疗的ESRD患者院内死亡的几个预后因素。
本研究回顾了2009年3月至2022年2月间林口长庚纪念医院重症监护病房90例接受静脉-动脉ECMO治疗的成年ESRD患者的病历。排除14例在接受ECMO支持后24小时内死亡的患者；其余76例患者被纳入研究。回顾性收集人口统计学、临床和实验室变量作为生存预测指标。主要结局是院内死亡率。
总体院内死亡率为69.7%。需要ECMO支持的最常见诊断是心脏术后心源性休克，最常见的ECMO相关并发症是感染。多因素逻辑回归分析显示，ECMO支持第1天的急性生理与慢性健康状况评分系统II（APACHE II）评分是院内死亡的独立危险因素。APACHE II评分在受试者工作特征曲线下面积显示出令人满意的鉴别能力（0.788±0.057）。APACHE II评分≤29分的患者与APACHE II评分>29分的患者在6个月随访时的累积生存率差异有统计学意义（p<0.001）。
对于接受ECMO治疗的ESRD患者，APACHE II评分是院内死亡的优秀预测指标。
