Ščupakova Nadežda, Žvirblis Tadas, Zorinas Aleksejus, Andrijauskas Povilas, Vicka Vaidas, Puodžiukaitė Lina, Šerpytis Pranas, Samalavičius Robertas Stasys
Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania.
Postepy Kardiol Interwencyjnej. 2025 May 29;21(2):221-228. doi: 10.5114/aic.2025.151722. eCollection 2025 Jun.
Despite the growing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO), there are still no clearly defined criteria for VA-ECMO initiation in postcardiotomy (PC) patients.
To identify the pre-ECMO risk factors associated with increased hospital mortality, paying special attention to the patients' age.
Retrospective review of consecutive adult patients supported with PC ECMO for a 16-year period in a tertiary care center. The primary outcome was all-cause mortality. Logistic regression was performed to identify mortality predictors. To determine the optimal age cut-off that most accurately distinguishes between higher and lower probabilities of mortality, the Youden index was used.
A total of 214 patients were enrolled in the final analysis and 55 (25.7%) survived until hospital discharge. Age was a significant mortality predictor with ROC-AUC of 0.596 (0.508-0.685), = 0.033. Multivariable logistic regression showed that age over 60 years (OR = 2.119 (95% CI: 1.055, 4.255), = 0.035), male gender (OR of 0.415, indicating a protective effect) (95% CI: 0.198, 0.869), = 0.020), pre-ECMO vasoactive inotropic score (VIS) (OR = 1.015 (95% CI: 1.002, 1.027), = 0.019), and mechanical ventilation duration before ECMO (OR = 1.053 (95% CI: 1.014, 1.092), = 0.007) remained as independent prognostic factors.
Our study confirms that advanced age is a prognostic marker of mortality in PC ECMO patients and doubles the mortality risk above 60 years. However, age must be considered alongside other mortality predictors. These findings can significantly contribute to the decision-making process.
尽管静脉-动脉体外膜肺氧合（VA-ECMO）的应用日益广泛，但对于心脏术后（PC）患者启动VA-ECMO尚无明确的标准。
确定与住院死亡率增加相关的体外膜肺氧合（ECMO）前危险因素，特别关注患者年龄。
对一家三级医疗中心16年间接受PC ECMO支持的连续成年患者进行回顾性研究。主要结局是全因死亡率。采用逻辑回归确定死亡率预测因素。为确定最准确区分高死亡率和低死亡率概率的最佳年龄分界点，使用了约登指数。
共有214例患者纳入最终分析，55例（25.7%）存活至出院。年龄是显著的死亡率预测因素，ROC-AUC为0.596（0.508 - 0.685），P = 0.033。多变量逻辑回归显示，60岁以上（比值比[OR] = 2.119（95%置信区间[CI]：1.055，4.255），P = 0.035）、男性（OR为0.415，显示有保护作用）（95% CI：0.198，0.869），P = 0.020）、ECMO前血管活性药物评分（VIS）（OR = 1.015（95% CI：1.002，1.027），P = 0.019）以及ECMO前机械通气时间（OR = 1.053（95% CI：1.014，1.092），P = 0.007）仍是独立的预后因素。
我们的研究证实，高龄是PC ECMO患者死亡率的预后指标，60岁以上患者死亡风险加倍。然而，年龄必须与其他死亡率预测因素一并考虑。这些发现可显著有助于决策过程。
