Related Experiment Videos
Prognostic indicators in VA-ECMO: Insights from thromboinflammatory markers
Shengqiang Pei1, Jie Xu1, Zixin Chen1
1Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, 100037, PR China.
Background:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving intervention for refractory cardiogenic shock but is frequently complicated by thromboinflammation, leading to high morbidity and mortality. Neutrophil extracellular traps (NETs) and S100A8/A9 are involved in the thromboinflammatory process, yet their value as prognostic biomarkers for adverse outcomes in VA-ECMO patients remains to be further elucidated.
Objective:
This study aimed to investigate the dynamic changes of NETs and S100A8/A9 in VA-ECMO patients and evaluate their predictive value for adverse outcomes.
Methods:
A prospective cohort of 24 critically ill patients undergoing VA-ECMO was consecutively enrolled. Plasma levels of CitH3, dsDNA, and S100A8/A9 were measured at three predefined time points: baseline, 48 h post-initiation, and pre-decannulation. Their associations with adverse clinical outcomes were analyzed. Additionally, DNaseI intervention was employed in rat VA-ECMO models to further validate the mechanistic role of NETs.
Results:
During VA-ECMO support, the thromboinflammatory markers S100A8/A9 and CitH3 remained persistently elevated, with significantly higher concentrations observed in the withdrawal group (54.2%) compared to the successful weaning group. Spearman's correlation analysis indicated significant positive associations between S100A8/A9, CitH3, dsDNA, and the withdrawal of ECMO support. ROC curve analysis demonstrated that these markers were superior to traditional indicators, such as C-reactive protein, in predicting the withdrawal of ECMO support. Multivariate Cox regression analysis identified CitH3 serve as better prognostic indicators in patients undergoing VA-ECMO. In a rat VA-ECMO model, DNaseI treatment effectively reduced S100A8/A9 levels, while significantly extending the duration of ECMO support, thereby providing proof-of-concept for NETs-targeted therapy.
Conclusion:
NETs-associated thromboinflammatory markers are closely associated with adverse outcomes in VA-ECMO patients and offer better prognostic value compared to traditional biomarkers. Targeting NETs may represent a promising therapeutic strategy to mitigate the thromboinflammatory burden and improve patient prognosis.
Related Concept Videos
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Pulmonary Embolism I: Introduction
Pulmonary Embolism I: Introduction
Pulmonary Embolism III: Nursing Management
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...