Li Jin, Li ChengLong, Wang Liangshan, Wang Xiaomeng, Xu Bo, Jiang Chunjing, Xin Meng, Guo Dong, Chen Jing, Du Zhongtao, Wang Hong, Hao Xing, Hou Xiaotong
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Shock. 2025 Jun 1;63(6):851-856. doi: 10.1097/SHK.0000000000002569. Epub 2025 Feb 26.
Introduction : Elevated cell-free DNA (cfDNA) was observed in patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO), but the clinical relevance of cfDNA is still not clear. We aimed to establish a predictive model based on the cfDNA to predict the prognosis for patients on ECMO, and reveal the values of cfDNA for complications of limb ischemia and bleeding/thromboembolic events. Methods : Single-center, retrospective evaluation of patients with ECMO support from 2018 through 2023. The derivation cohort included 133 adults diagnosed with cardiogenic shock who received VA-ECMO for circulatory support. We developed three independent features and combined them with a logistic model to predict mortality. Predictive performance was assessed through Bootstrap analysis and validated by another cohort of 27 patients. The values of cfDNA for complications were analyzed by restricted cubic spline analysis, receiver-operating characteristic curves and multivariate regression analyses. Results : A total of 133 adults who underwent VA-ECMO for refractory cardiogenic shock were entered into the derivation cohort. The logistic model, consisted of cfDNA, the worst mean arterial pressure (MAP) before ECMO and the worst lactate within 24 h of VA-ECMO implantation was predictive and performed similarly for validation cohorts (area under the receiver operating characteristic curve: 0.768 vs. 0.747). Restricted cubic spline analysis revealed a positive linear relationship for the risk of limb ischemia (linear, P = 0.006; area under the receiver operating characteristic curve of 0.75 [95% CI, 0.656-0.848]), a U-shaped trend for bleeding events (nonlinear, P = 0.214), and a negative trend for thrombotic events (linear, P = 0.552). Conclusions: In addition to MAP and lactate levels, elevated cfDNA levels within 48 h of ECMO support were highly associated with mortality for patients. Additionally, cfDNA is predictive of limb ischemia.
在接受静脉-动脉（VA）体外膜肺氧合（ECMO）治疗的患者中观察到游离DNA（cfDNA）水平升高，但cfDNA的临床相关性仍不明确。我们旨在建立基于cfDNA的预测模型，以预测接受ECMO治疗患者的预后，并揭示cfDNA在肢体缺血和出血/血栓栓塞事件并发症中的价值。方法：对2018年至2023年接受ECMO支持的患者进行单中心回顾性评估。推导队列包括133名被诊断为心源性休克并接受VA-ECMO循环支持的成年人。我们开发了三个独立特征，并将其与逻辑模型相结合以预测死亡率。通过Bootstrap分析评估预测性能，并在另一组27名患者中进行验证。通过受限立方样条分析、受试者工作特征曲线和多变量回归分析来分析cfDNA在并发症中的价值。结果：共有133名因难治性心源性休克接受VA-ECMO治疗的成年人进入推导队列。由cfDNA、ECMO前最差平均动脉压（MAP）和VA-ECMO植入后24小时内最差乳酸水平组成的逻辑模型具有预测性，在验证队列中的表现相似（受试者工作特征曲线下面积：0.768对0.747）。受限立方样条分析显示，肢体缺血风险呈正线性关系（线性，P = 0.006；受试者工作特征曲线下面积为0.75 [95% CI，0.656 - 0.848]），出血事件呈U形趋势（非线性，P = 0.214），血栓形成事件呈负趋势（线性，P = 0.552）。结论：除MAP和乳酸水平外，ECMO支持48小时内cfDNA水平升高与患者死亡率高度相关。此外，cfDNA可预测肢体缺血。
