Risk factors for mortality in surgical patients on combined continuous renal replacement therapy and extracorporeal membrane oxygenation: single-center retrospective study

被引:3
作者
Huang, Suiqing [1 ]
Wang, Junjie [1 ]
Feng, Kangni [1 ]
Wu, Huawei [2 ]
Shang, Liqun [1 ]
Huang, Yang [1 ]
Zhou, Zhuoming [1 ]
Li, Huayang [1 ]
Liu, Quan [1 ]
Chen, Jiantao [1 ]
Liang, Mengya [1 ]
Hou, Jian [1 ,3 ]
Chen, Guangxian [1 ,4 ]
Wu, Zhongkai [1 ]
机构
[1] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Cardiac Surg, 58 Zhongshan 2 Rd, Guangzhou 510080, Peoples R China
[2] Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY USA
[3] Guangzhou Panyu Cent Hosp, Dept Cardiol, Guangzhou, Peoples R China
[4] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Cardiothorac Surg ICU, Guangzhou, Peoples R China
关键词
Extracorporeal membrane oxygenation; continuous renal replacement therapy; acute renal injury; risk factors; surgery; mortality; CRITICALLY-ILL PATIENTS; APACHE-II; FAILURE; ECMO; MANAGEMENT; OUTCOMES; IMPACT; PROGNOSIS; SEVERITY; SURGERY;
D O I
10.1080/0886022X.2023.2282019
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objective In patients receiving extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT) is increasingly being used for renal replacement and fluid management. However, critically ill surgical patients receiving combined ECMO and CRRT tend to have a high mortality rate, and there are limited studies on this population. Therefore, we aimed to investigate the risk factors for mortality in surgical patients receiving combined ECMO and CRRT.Methods Data of surgical patients who underwent ECMO between December 2013 and April 2023 were retrospectively reviewed. Univariate and multivariate logistic regression analysis were used to identify the risk variables. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff value of albumin and age to predict death.Results A total of 199 patients on ECMO support were screened, of which 105 patients were included in the final analysis. Of 105 patients, 77 (73.33%) were treated with CRRT. Veno-arterial ECMO was performed in 97 cases (92.38%), and the rest were veno-venous ECMO (n = 8, 7.62%). Cardiovascular-related surgery was performed in the main patients (n = 86, 81.90%) and other types of surgery in 19 patients. In surgical patients on ECMO support, the logistic regression analysis showed that CRRT implantation, male sex, and age were the independent risks factors for mortality. Furthermore, the ROC curve analysis showed that age 48.5 years had the highest Youden index. In surgical patients on combined CRRT and ECMO, age, valvular heart disease, and albumin were the independent risk factors for prognosis. Albumin had the highest Youden index at a cutoff value of 39.95 g/L for predicting mortality, though the overall predictive value was modest (area under ROC 0.704). Age had the highest Youden index at a cutoff value of 48.5 years for predicting mortality.Conclusions In our cohort of surgical patients requiring ECMO, which consisted mostly of patients undergoing cardiovascular surgery requiring VA-ECMO, the need for CRRT was an independent risk factor for mortality. In the subset of patients on combined CRRT and ECMO, independent risk factors for mortality included higher age, lack of valvular heart disease, and lower serum albumin.
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页数:8
相关论文
共 39 条
  • [1] The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy
    Antonucci, Elio
    Lamanna, Irene
    Fagnoul, David
    Vincent, Jean-Louis
    De Backer, Daniel
    Taccone, Fabio Silvio
    [J]. ARTIFICIAL ORGANS, 2016, 40 (08) : 746 - 754
  • [2] Renal Replacement Therapy in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation
    Askenazi, David J.
    Selewski, David T.
    Paden, Matthew L.
    Cooper, David S.
    Bridges, Brian C.
    Zappitelli, Michael
    Fleming, Geoffrey M.
    [J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2012, 7 (08): : 1328 - 1336
  • [3] Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study
    Bagshaw, SM
    Laupland, KB
    Doig, CJ
    Mortis, G
    Fick, GH
    Mucenski, M
    Godinez-Luna, T
    Svenson, LW
    Rosenal, T
    [J]. CRITICAL CARE, 2005, 9 (06): : R700 - R709
  • [4] Haemofiltration in newborns treated with extracorporeal membrane oxygenation: a case-comparison study
    Blijdorp, Karin
    Cransberg, Karlien
    Wildschut, Enno D.
    Gischler, Saskia J.
    Houmes, Robert Jan
    Wolff, Eric D.
    Tibboel, Dick
    [J]. CRITICAL CARE, 2009, 13 (02):
  • [5] Cheng YC, 2020, KIDNEY INT, V97, P829, DOI 10.1016/j.kint.2020.03.005
  • [6] Outcomes among Patients Treated with Renal Replacement Therapy during Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study
    Dado, David N.
    Ainsworth, Craig R.
    Thomas, Sarah B.
    Huang, Benjamin
    Piper, Lydia C.
    Sams, Valerie G.
    Batchinsky, Andriy
    Morrow, Benjamin D.
    Basel, Anthony P.
    Walter, Robert J.
    Mason, Phillip E.
    Chung, Kevin K.
    [J]. BLOOD PURIFICATION, 2020, 49 (03) : 341 - 347
  • [7] A Multicenter International Survey of Renal Supportive Therapy During ECMO: The Kidney Intervention During Extracorporeal Membrane Oxygenation (KIDMO) Group
    Fleming, Geoffrey M.
    Askenazi, David J.
    Bridges, Brian C.
    Cooper, David S.
    Paden, Mathew L.
    Selewski, David T.
    Zappitelli, Michael
    [J]. ASAIO JOURNAL, 2012, 58 (04) : 407 - 414
  • [8] Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis
    Friedrich, Jan O.
    Wald, Ron
    Bagshaw, Sean M.
    Burns, Karen E. A.
    Adhikari, Neill K. J.
    [J]. CRITICAL CARE, 2012, 16 (04)
  • [9] Outcomes associated with the use of renal replacement therapy in children receiving extracorporeal membrane oxygenation after heart surgery: a multi-institutional analysis
    Gupta, Punkaj
    Beam, Brandon
    Schmitz, Michael L.
    [J]. PEDIATRIC NEPHROLOGY, 2015, 30 (06) : 1019 - 1026
  • [10] Effects of Renal Replacement Therapy in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis
    Han, Seon-Sook
    Kim, Hyun Jung
    Lee, Seung Joon
    Kim, Woo Jin
    Hong, Youngi
    Lee, Hui-Young
    Song, Seo-Young
    Jung, Hae Hyuk
    Ahn, Hyeong Sik
    Ahn, Il Min
    Baek, Hyunjeong
    [J]. ANNALS OF THORACIC SURGERY, 2015, 100 (04) : 1485 - 1495