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Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study

Despite gaining popularity, venovenous extracorporeal membrane oxygenation (VV-ECMO) remains a controversial therapy for acute respiratory failure (ARF) in adult patients due to its equivocal survival benefits. The study was aimed at identifying the preinterventional prognostic predictors of hospita...

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Autores principales: Cheng, Yu-Ting, Wu, Meng-Yu, Chang, Yu-Sheng, Huang, Chung-Chi, Lin, Pyng-Jing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265867/
https://www.ncbi.nlm.nih.gov/pubmed/27472730
http://dx.doi.org/10.1097/MD.0000000000004380
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author Cheng, Yu-Ting
Wu, Meng-Yu
Chang, Yu-Sheng
Huang, Chung-Chi
Lin, Pyng-Jing
author_facet Cheng, Yu-Ting
Wu, Meng-Yu
Chang, Yu-Sheng
Huang, Chung-Chi
Lin, Pyng-Jing
author_sort Cheng, Yu-Ting
collection PubMed
description Despite gaining popularity, venovenous extracorporeal membrane oxygenation (VV-ECMO) remains a controversial therapy for acute respiratory failure (ARF) in adult patients due to its equivocal survival benefits. The study was aimed at identifying the preinterventional prognostic predictors of hospital mortality in adult VV-ECMO patients and developing a practical mortality prediction score to facilitate clinical decision-making. This retrospective study included 116 adult patients who received VV-ECMO for severe ARF in a tertiary referral center, from 2007 to 2015. The definition of severe ARF was P(a)O(2)/ FiO(2) ratio < 70 mm Hg under advanced mechanical ventilation (MV). Preinterventional variables including demographic characteristics, ventilatory parameters, and severity of organ dysfunction were collected for analysis. The prognostic predictors of hospital mortality were generated with multivariate logistic regression and transformed into a scoring system. The discriminative power on hospital mortality of the scoring system was presented as the area under receiver operating characteristic curve (AUROC). The overall hospital mortality rate was 47% (n = 54). Pre-ECMO MV day > 4 (OR: 4.71; 95% CI: 1.98–11.23; P < 0.001), pre-ECMO sequential organ failure assessment (SOFA) score >9 (OR: 3.16; 95% CI: 1.36–7.36; P = 0.01), and immunocompromised status (OR: 2.91; 95% CI: 1.07–7.89; P = 0.04) were independent predictors of hospital mortality of adult VV-ECMO. A mortality prediction score comprising of the 3 binary predictors was developed and named VV-ECMO mortality score. The total score was estimated as follows: VV-ECMO mortality score = 2 × (Pre-ECMO MV day > 4) + 1 × (Pre-ECMO SOFA score >9) + 1 × (immunocompromised status). The AUROC of VV-ECMO mortality score was 0.76 (95% CI: 0.67–0.85; P < 0.001). The corresponding hospital mortality rates to VV-ECMO mortality scores were 18% (Score 0), 35% (Score 1), 56% (Score 2), 75% (Score 3), and 88% (Score 4), respectively. Duration of MV, severity of organ dysfunction, and immunocompromised status were important preinterventional prognostic predictors for adult VV-ECMO. The 3 prognostic predictors could also constitute a practical prognosticating tool in patients requiring this advanced respiratory support. Physicians in ECMO institutions are encouraged to perform external validations of this prognosticating tool and make contributions to score optimization.
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spelling pubmed-52658672017-02-03 Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study Cheng, Yu-Ting Wu, Meng-Yu Chang, Yu-Sheng Huang, Chung-Chi Lin, Pyng-Jing Medicine (Baltimore) 3900 Despite gaining popularity, venovenous extracorporeal membrane oxygenation (VV-ECMO) remains a controversial therapy for acute respiratory failure (ARF) in adult patients due to its equivocal survival benefits. The study was aimed at identifying the preinterventional prognostic predictors of hospital mortality in adult VV-ECMO patients and developing a practical mortality prediction score to facilitate clinical decision-making. This retrospective study included 116 adult patients who received VV-ECMO for severe ARF in a tertiary referral center, from 2007 to 2015. The definition of severe ARF was P(a)O(2)/ FiO(2) ratio < 70 mm Hg under advanced mechanical ventilation (MV). Preinterventional variables including demographic characteristics, ventilatory parameters, and severity of organ dysfunction were collected for analysis. The prognostic predictors of hospital mortality were generated with multivariate logistic regression and transformed into a scoring system. The discriminative power on hospital mortality of the scoring system was presented as the area under receiver operating characteristic curve (AUROC). The overall hospital mortality rate was 47% (n = 54). Pre-ECMO MV day > 4 (OR: 4.71; 95% CI: 1.98–11.23; P < 0.001), pre-ECMO sequential organ failure assessment (SOFA) score >9 (OR: 3.16; 95% CI: 1.36–7.36; P = 0.01), and immunocompromised status (OR: 2.91; 95% CI: 1.07–7.89; P = 0.04) were independent predictors of hospital mortality of adult VV-ECMO. A mortality prediction score comprising of the 3 binary predictors was developed and named VV-ECMO mortality score. The total score was estimated as follows: VV-ECMO mortality score = 2 × (Pre-ECMO MV day > 4) + 1 × (Pre-ECMO SOFA score >9) + 1 × (immunocompromised status). The AUROC of VV-ECMO mortality score was 0.76 (95% CI: 0.67–0.85; P < 0.001). The corresponding hospital mortality rates to VV-ECMO mortality scores were 18% (Score 0), 35% (Score 1), 56% (Score 2), 75% (Score 3), and 88% (Score 4), respectively. Duration of MV, severity of organ dysfunction, and immunocompromised status were important preinterventional prognostic predictors for adult VV-ECMO. The 3 prognostic predictors could also constitute a practical prognosticating tool in patients requiring this advanced respiratory support. Physicians in ECMO institutions are encouraged to perform external validations of this prognosticating tool and make contributions to score optimization. Wolters Kluwer Health 2016-07-29 /pmc/articles/PMC5265867/ /pubmed/27472730 http://dx.doi.org/10.1097/MD.0000000000004380 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3900
Cheng, Yu-Ting
Wu, Meng-Yu
Chang, Yu-Sheng
Huang, Chung-Chi
Lin, Pyng-Jing
Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study
title Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study
title_full Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study
title_fullStr Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study
title_full_unstemmed Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study
title_short Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study
title_sort developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: a pilot study
topic 3900
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265867/
https://www.ncbi.nlm.nih.gov/pubmed/27472730
http://dx.doi.org/10.1097/MD.0000000000004380
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