Fresh frozen plasma transfusion is a potential predictor of mortality in patients undergoing extracorporeal membrane oxygenation

Abstract

Background The patients of extracorporeal membrane oxygenation (ECMO) supported were usually developed bleeding complications and required substantial transfusions, but the risks and predictors of transfusion requirements during ECMO support remain uncertain. This study aims to interpret the risk factors of ECMO patients' in-hospital mortality and investigate the predictors of blood transfusion in ECMO patients.Methods 113 ECMO patients’ clinical parameters were collected in the cohorts. The logistic regression and least absolute shrinkage and selection operator (LASSO) binomial regression analysis were employed to identify the risk factors of ECMO patients' in-hospital mortality. Machine learning approaches were performed to confirm the variable importance. The backward stepwise multiple linear regression analyses were used to examine the predictive values of candidate importance variables. Results Eleven variables including age, coronary heart disease (CHD), multiple organ failure, bleeding complications, anemia, fresh frozen plasma (FFP) transfusion, platelet (PLT) transfusion, direct bilirubin (DBIL), lactate dehydrogenase (LDH), activated partial thromboplastin time (APTT), and ECMO duration were identified could as independent predictors for patients’ mortality. Age, FFP transfusion and ECMO duration were the top three important indexes among eleven variables in the selection of feature importance, and with the risk contribution values were 1.03 (95% CI, 1.01-1.06; p = 0.014), 1.07 (95% CI, 1.01-1.14; p = 0.026) and 1.05 (95% CI, 1.00-1.09; p = 0.043), respectively. FFP transfusion over 2.5 mL/kg/d, age over 48 years old more likely dead in ECMO patients. Furthermore, APTT (R=0. 32, p<0.001), PLT counts (R=-0.40, p<0.001) and uric acid (UA) (R=0.39, p<0.001) were associated with the FFP transfusion, which could as an independent factor for predicting FFP transfusion, with the estimate values were 0.06 (95% CI, 0.02-0.11; p = 0.009), -0.03 (95% CI, -0.05--0.01; p = 0.007) and 0.01 (95% CI, 0.00-0.02; p = 0.003), respectively.Conclusion FFP transfusion was markedly associated with in-hospital mortality among patients receiving ECMO, and APTT, PLT counts and UA were the influence factors for FFP transfusion. It is suggesting that better monitoring of the above three indicators may reduce utilization of FFP, thus improving ECMO patients’ outcomes.