Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supports patients suffering from refractory cardiogenic shock. Thromboembolic complications (TeC) are common in VA-ECMO patients and are associated with increased morbidity and mortality. Valid markers to predict TeC in VA-ECMO patients are lacking. The present study investigated the predictive value of baseline Fibrinogen–Albumin-Ratio (FAR) for in-hospital TeC in patients undergoing VA-ECMO. This retrospective cohort study included patients who underwent VA-ECMO therapy due to cardiogenic shock at the University Hospital Duesseldorf, Germany between 2011 and 2018. Main exposure was baseline FAR measured at initiation of VA-ECMO therapy. The primary endpoint was the in-hospital incidence of TeC. In total, 344 patients were included into analysis (74.7% male, mean age 59 ± 14 years). The in-hospital incidence of TeC was 34%. Receiver operating characteristics (ROC) curve of FAR for in-hospital TeC revealed an area under the curve of 0.67 [95% confidence interval (CI) 0.61–0.74]. Youden index determined a cutoff of 130 for baseline FAR. Multivariate logistic regression revealed an adjusted odds-ratio of 3.72 [95% CI 2.26–6.14] for the association between FAR and TeC. Baseline FAR is independently associated with in-hospital TeC in patients undergoing VA-ECMO. Thus, FAR might contribute to the prediction of TeC in this cohort.
The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasing, but mortality remains high. Early assessment of prognosis is challenging and valid markers are lacking. This study aimed to investigate Neutrophil–Lymphocyte Ratio (NLR), Platelet-Lymphocyte-Ratio (PLR) and Procalcitonin (PCT) for early assessment of prognosis in patients undergoing VA-ECMO. This retrospective single-center cohort study included 344 consecutive patients ≥ 18 years who underwent VA-ECMO due to cardiogenic shock. Main exposures were NLR, PLR and PCT measured within 24 h after VA-ECMO initiation. The primary endpoint was all-cause in-hospital mortality. In total, 92 patients were included into final analysis (71.7% male, age 57 ± 14 years). In-hospital mortality rate was 48.9%. Receiver operating characteristics (ROC) curve revealed an area under the curve (AUC) of 0.65 [95% confidence interval (CI) 0.53–0.76] for NLR. The AUCs of PLR and PCT were 0.47 [95%CI 0.35–0.59] and 0.54 [95%CI 0.42–0.66], respectively. Binary logistic regression showed an adjusted odds ratio of 3.32 [95%CI 1.13–9.76] for NLR, 1.0 [95%CI 0.998–1.002] for PLR and 1.02 [95%CI 0.99–1.05] for PCT. NLR is independently associated with in-hospital mortality in patients undergoing VA-ECMO. However, discriminative ability is weak. PLR and PCT seem not to be suitable for this purpose.
Introduction and objectivesStandard of care treatments for asthma and COPD are commonly administered in single-dose or multidose dry powder inhalers. There is a dearth of evidence around the prevalence of comorbidities, especially those that may affect inhaler device handling, among Swedish asthma and COPD patients.MethodsThis retrospective study from the Swedish National Health Registries included 495,254 patients receiving inpatient or specialised outpatient care in Sweden between January 1, 2005 and December 31, 2014. Estimates of severity were based on number of asthma/COPD drugs used. Diagnostic codes were used to assess number of patients with a pre-specified comorbidity potentially affecting device handling.ResultsPatient characteristics, treatments and comorbidities are summarised in the Table. Comorbidities that may impact inhaler handling were observed in 15.8% (asthma), 50.4% (COPD) and 55.3% (asthma/COPD) patients; incidence was increased with disease severity (patients with severe disease: 26.3%, 52.0%, 55.9%) and advanced age (patients 60–69 years: 33.2%, 45.2%, 50.5%, respectively).ConclusionsComorbidities potentially affecting device handling were common across all groups, and unexpectedly high among elderly asthma patients. Furthermore, the data indicate that a substantial percentage of patients use two or more separate inhalers. These findings highlight the need for newer, easier to use inhalers, as well as training and monitoring of device use in patients who may have more difficulties using their devices correctly due to comorbidities.Abstract P140 Table 1Asthma (n = 394,160)COPD (n = 77,749)Asthma and COPD (n = 23,345)Mean age, year (SD)28.9 (24.7)72.8 (9.8)71.7 (10.9)Male50.6%47.5%38.5%SeverityMild/moderate/severe/very severe61.4%/34.9%/3.6%/0%42.8%/38.8%/16.0%/2.4%23.0%/44.3%/27.7%/5.0%Mean Charlson Comorbidity index (SD)1.3 (1.1)3.0 (2.2)2.9 (2.2)Treatments (used by ≥20% patients in any group)Short-acting beta-agonists69.8%45.1%61.6%LABA8.9%16.5%20.2%Long-acting muscarinic-antagonist2.2%71.6%50.7%ICS53.5%16.5%27.6%Fixed ICS/LABA combinations34.9%57.5%68.3%Antibiotics13.8%33.3%37.0%Oral steroids20.9%32.4%43.1%Comorbidities that can affect inhaler handling (observed in ≥10% patients in any group)Any15.8%50.4%55.3%Heart failure2.0%21.8%22.9%Stroke1.6%10.8%9.7%Sleep disorders3.8%7.2%10.5%Depression or anxiety8.1%14.4%17.7%Osteoporosis1.2%7.7%10.2%COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; LABA, long-acting beta-agonists; SD, standard deviation.
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