Precannulation International Normalized Ratio is Independently Associated With Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation

Plazak, Michael E; Grazioli, Alison; Powell, Eleanor A.; Menne, Ashley; Bathula, Allison; Madathil, Ronson J.; Krause, Eric; Deatrick, Kristopher B.; Mazzeffi, Michael

doi:10.1053/j.jvca.2021.07.007

Cited by 1 publication

(2 citation statements)

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“…Although different coagulation tests are used in patients with MCS devices, some studies investigated the prognostic role of the PT/INR in patients treated with VA-ECMO. The prognostic value of the INR before cannulation was investigated in 188 patients undergoing VA-ECMO insertion for CS or extracorporeal cardiopulmonary resuscitation, suggesting an INR > 1.8 was associated with a higher risk of in-hospital mortality as compared to patients with lower INR values [24]. In line with this, Pabst et al demonstrated an INR > 2.0 was associated with increased in-hospital mortality among 61 patients treated with VA-ECMO for AMI-related CS [36]; however, within the present study, only 10% were treated with an additional MCS device.…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic value of the PT/INR was investigated within various clinical conditions including patients with trauma, sepsis, critically ill patients and in patients treated with MCS devices, whereas studies investigating the role of the PT/INR in consecutive CS patients are limited [13,14,18,[23][24][25]; however, the frequency of bleeding events and associated outcomes was investigated within few studies including patients with CS. In patients suffering from CS, bleeding rates were reported in 21.5% of patients enrolled in the CULPRIT-SHOCK trial and associated with prolonged catecholamine therapy, duration of mechanical ventilation and all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

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The prothrombin time/international normalized ratio predicts prognosis in cardiogenic shock

Schupp

Behnes

Rusnak

et al. 2023

Coronary Artery Disease

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Objective The study investigates the prognostic impact of the prothrombin time/international normalized ratio (PT/INR) in patients with cardiogenic shock. Background Despite ongoing improvements regarding the treatment of cardiogenic shock patients, intensive care unit (ICU)-related mortality in cardiogenic shock patients remains unacceptably high. Limited data regarding the prognostic value of the PT/INR during the course of cardiogenic shock treatment is available. Methods All consecutive patients with cardiogenic shock from 2019 to 2021 were included at one institution. Laboratory values were collected from the day of disease onset (day 1) and days 2, 3, 4 and 8. The prognostic impact of the PT/INR was tested for 30-day all-cause mortality, as well as the prognostic role of PT/INR changes during course of ICU hospitalization. Statistical analyses included univariable t-test, Spearman’s correlation, Kaplan–Meier analyses, C-Statistics and Cox proportional regression analyses. Results Two hundred twenty-four cardiogenic shock patients were included with a rate of all-cause mortality at 30 days of 52%. The median PT/INR on day 1 was 1.17. The PT/INR on day 1 was able to discriminate 30-day all-cause mortality in cardiogenic shock patients [area under the curve 0.618; 95% confidence interval (CI), 0.544–0.692; P = 0.002). Patients with PT/INR > 1.17 were associated with an increased risk of 30-day mortality [62% vs. 44%; hazard ratio (HR) = 1.692; 95% CI, 1.174–2.438; P = 0.005], which was still evident after multivariable adjustment (HR = 1.551; 95% CI, 1.043–2.305; P = 0.030). Furthermore, especially patients with an increment of the PT/INR by ≥10% from day 1 to day 2 were associated with an increased risk of 30-day all-cause mortality (64% vs. 42%; log-rank P = 0.014; HR = 1.833; 95% CI, 1.106–3.038; P = 0.019). Conclusion Baseline PT/INR and an increase of the PT/INR during the course of ICU treatment were associated with the risk of 30-day all-cause mortality in cardiogenic shock patients.

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Section: Discussionmentioning

confidence: 99%