Chen Zhifeng, Su Guiyuan, Zhao Guohui, Dong Yang, Xiao Junzhi, Yin Haiyan
Department of Critical Care Medicine, The First Affiliated Hospital of Jinan University Guangzhou 510632, Guangdong, China.
Department of Critical Care Medicine, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City) Changde 415000, Hunan, China.
Am J Transl Res. 2025 Jun 15;17(6):4839-4848. doi: 10.62347/AKFK5120. eCollection 2025.
To identify risk factors for bleeding and thrombotic complications during extracorporeal membrane oxygenation (ECMO) support in adults and to develop a predictive model based on these factors.
Data from 323 adult patients treated with ECMO in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were retrospectively analyzed. Demographic information, clinical characteristics, and laboratory test results were collected. Kaplan-Meier (K-M) and Cox regression analyses were used to identify risk factors for bleeding and thrombotic complications and construct a predictive model.
Bleeding and thrombotic complications was noted in 84 (26.0%) patients, with a median onset time of 13 days after ECMO. Univariate analysis identified age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ECMO indication, ECMO withdrawal, extracorporeal cardiopulmonary resuscitation (ECPR), and coagulation function as potential risk factors (all P < 0.05). Multivariate analysis revealed that ECMO withdrawal and platelet count (PLT) were independent protective factors, while D-dimer was an independent risk factor (P < 0.05). A predictive model was developed based on ECMO withdrawal, D-dimer, and PLT, with areas under the curves (AUCs) of 0.932, 0.931, and 0.941 for predicting bleeding complications at 6, 9, and 12 days after ECMO treatment, respectively.
The incidence of ECMO-related bleeding and thrombotic complications is high. ECMO withdrawal, PLT, and D-dimer are independent influencing factors. This predictive model can assist in early identification of high-risk patients and guide clinical decision-making.
确定成人体外膜肺氧合（ECMO）支持期间出血和血栓形成并发症的危险因素，并基于这些因素建立预测模型。
对重症监护医学信息数据库IV（MIMIC-IV）中323例接受ECMO治疗的成年患者的数据进行回顾性分析。收集人口统计学信息、临床特征和实验室检查结果。采用Kaplan-Meier（K-M）和Cox回归分析确定出血和血栓形成并发症的危险因素，并构建预测模型。
84例（26.0%）患者出现出血和血栓形成并发症，ECMO后中位发病时间为13天。单因素分析确定年龄、急性生理与慢性健康状况评分系统II（APACHE II）评分、ECMO适应证、ECMO撤机、体外心肺复苏（ECPR）和凝血功能为潜在危险因素（均P<0.05）。多因素分析显示，ECMO撤机和血小板计数（PLT）是独立的保护因素，而D-二聚体是独立的危险因素（P<0.05）。基于ECMO撤机、D-二聚体和PLT建立了预测模型，在ECMO治疗后6、9和12天预测出血并发症的曲线下面积（AUC）分别为0.932、0.931和0.941。
ECMO相关出血和血栓形成并发症的发生率较高。ECMO撤机、PLT和D-二聚体是独立的影响因素。该预测模型有助于早期识别高危患者并指导临床决策。
