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Risk factors for mortality in patients with sepsis on extracorporeal membrane oxygenation and/or continuous renal replacement therapy: a retrospective cohort study based on MIMIC-IV database

  • 0Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Renal Failure +

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December 4, 2024

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December 4, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

For septic patients on extracorporeal membrane oxygenation (ECMO), elevated prothrombin time increases mortality risk. For those on continuous renal replacement therapy (CRRT), SOFA score is key. Hypertension history is critical for patients on both.

Area Of Science

  • Critical Care Medicine
  • Nephrology
  • Cardiovascular Support

Background

  • Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
  • Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are life-support modalities used in severe sepsis.
  • Identifying mortality risk factors in these critically ill patients is crucial for improving outcomes.

Purpose Of The Study

  • To identify independent risk factors for mortality in septic patients undergoing ECMO and/or CRRT.
  • To analyze risk factors specific to patients receiving ECMO alone, CRRT alone, or both therapies concurrently.

Main Methods

  • Retrospective analysis of 24,502 septic patients from the MIMIC-IV database (2008-2019).
  • Inclusion of 70 patients on ECMO, 513 on CRRT, and 22 on both therapies.
  • Application of univariate and multivariate stepwise Cox regression, and receiver operating characteristic (ROC) curve analysis.

Main Results

  • For ECMO patients, elevated prothrombin time was a significant mortality risk factor (HR 1.037).
  • For CRRT patients, higher SOFA scores indicated increased mortality risk (HR 1.100).
  • For patients on both ECMO and CRRT, a prior history of hypertension was the sole independent risk factor (HR 4.342). ROC analysis demonstrated AUC > 0.75.

Conclusions

  • Prothrombin time is a key mortality predictor for septic patients on ECMO.
  • SOFA score is the most significant mortality predictor for septic patients on CRRT.
  • Hypertension history is the primary mortality risk factor for septic patients requiring both ECMO and CRRT.

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