在接受VA ECMO治疗的患者中,急性损伤和心脏性休克严重程度对死亡风险分层的影响
Chenglong Li1, Yiwen Wang1, Xiaomeng Wang1
1Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
ESC heart failure
|July 22, 2024
概括
急性损伤 (AKI) 阶段和心血管血管血管学会和干预 (SCAI) 休克阶段是静脉外体膜氧化 (VA ECMO) 患者心脏性休克 (CS) 患者死亡率的关键预测因素. 结合这些标志物可以改善死亡风险分层.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種神經病學.
- 临界护理医学 临界护理医学
背景情况:
- 心脏性休克 (CS) 是一种严重的疾病,需要先进的循环支持.
- 静脉外体膜氧化 (VA ECMO) 用于CS患者,但具有显著的死亡风险.
- 急性损伤 (AKI) 是CS的一个常见并发症,可能表明器官 perfusion 差.
研究的目的:
- 评估AKI阶段和心血管血管图谱和干预协会 (SCAI) 对接受VA ECMO治疗的CS患者的休克阶段的预后价值.
- 为了确定是否结合AKI和SCAI冲击阶段可以改善死亡风险分层.
- 在CS和VAECMO支持的背景下,评估AKI作为器官 perfusion 的指数.
主要方法:
- 在2018年1月至2020年12月期间接受VA ECMO的216名成年CS患者的回顾性分析.
- 在VA ECMO启动后48小时内评估最高的AKI阶段,使用病:改善整体结果 (KDIGO) 标准.
- 根据AKI和SCAI冲击阶段对患者进行分层,以分析住院死亡率.
主要成果:
- 在接受VA ECMO治疗的CS患者中,84.3%发生了AKI.
- 更高的AKI阶段 (特别是第三阶段) 和更高的SCAI冲击阶段与增加的住院死亡率 (P < 0.001) 有显著的关联.
- 结合的AKI和SCAI冲击阶段显示,与单个标记或其他得分相比,接收器操作特征曲线 (0.754) 下的区域在预测死亡率方面优越.
结论:
- 在需要VA ECMO的CS患者中,AKI非常普遍.
- AKI阶段,反射器官 perfusion 和 SCAI 冲击阶段是住院死亡率的独立预测因素.
- 结合AKI阶段和SCAI冲击阶段,为这种患者群体的死亡风险分层提供了一个强大的工具.
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