Yellow Means Caution: Correlations Between Liver Injury and Mortality with the Use of VA-ECMO

Masha, Luke; Peerbhai, Shareez; Boone, David L.; Shobayo, Fisayomi; Ghotra, Aman; Akkanti, Bindu; Zhao, Yelin; Banjac, Igor; Gregorič, Igor D.; Kar, Biswajit

doi:10.1097/mat.0000000000000895

Cited by 18 publications

(22 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A retrospective institutional database query found that the relevant parameters of liver function are usually normal before VA-ECMO initiation, but abnormalities in various markers develop after ECMO initiation. Finally, both bilirubin and lactate elevations correlated with increased mortality (22). Using a quantitative model, we definitively demonstrate that hyperbilirubinemia after ECMO initiation is a dominant factor in decreased survival and establish 65 µmol/L as the best cutoff value.…”

Section: Discussionmentioning

confidence: 66%

Serum Total Bilirubin With Hospital Survival in Adults During Extracorporeal Membrane Oxygenation

et al. 2022

View full text Add to dashboard Cite

BackgroundExtracorporeal membrane oxygenation (ECMO) is widely used for refractory cardiopulmonary failure treatment. The disadvantage of ECMO is its higher risk profile and clinical resource consumption. This observation examines the role of serum total bilirubin (TBIL) as a predictor of adult patient outcomes on ECMO support.MethodsThis retrospective observation reports a single-center experience with adults on ECMO support between 2018 and 2021. Data were collected regarding demographics, ECMO details, laboratory parameters, and outcomes. We examined the elevation of TBIL to predict survival and variables associated with hyperbilirubinemia.ResultsThe patients who died within 28 days had a twofold higher peak level of TBIL than those who survived [73.10 (38.60, 98.64) vs. 34.50 (24.03, 54.85); P = 0.003]. Univariate logistic regression analyses demonstrated that high TBIL was remarkably associated with an elevated risk of 28-day mortality (OR: 7.25; 95% CI: 2.31–25.49; P = 0.001) and total mortality (OR: 5.71; 95% CI: 1.82–20.66; P = 0.001). The TBIL value was 65 μmol/L as the best cut-off value, and the observation group was divided into a high TBIL subgroup (n = 21) or a low TBIL subgroup (n = 39). The demographic and clinical features did not show a difference, whereas Sequential Organ Failure Assessment (SOFA) and APACHE II scores and ALT, AST, and LAC before ECMO initiation correlated with high or low TBIL (P < 0.05). For coagulation function at the time of TBIL peak, the levels of prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin time activity (PTA), and fibrinogen (FIB) were different between the two subgroups (P < 0.05). The SOFA score was potentially associated with hyperbilirubinemia after ECMO initiation, and the prediction accuracy was 0.800.ConclusionSerum total bilirubin elevation appears after ECMO initiation and correlates with survival, while other markers of liver injury do not. Serum total bilirubin is an easy-to-measure biomarker to be a predictor of survival after ECMO initiation.

show abstract

Section: Discussionmentioning

confidence: 66%

Serum Total Bilirubin With Hospital Survival in Adults During Extracorporeal Membrane Oxygenation

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Liver failure as an independent risk factor for mortality has previously not been described in larger studies and is supported by only limited literature regarding this topic. Altered liver parameters during ECLS therapy are known (27). The MELD-XI score is predictive of mortality in ECLS (28,29).…”

Section: Discussionmentioning

confidence: 99%

Predictors associated with mortality of extracorporeal life support therapy for acute heart failure: single-center experience with 679 patients

Sahli¹,

Kaserer²,

Braun³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

Background: Extracorporeal life support (ECLS) therapy is increasingly used for cardiac and respiratory support postcardiotomy, refractory cardiogenic shock and cardiopulmonary resuscitation. This study aims to describe in-hospital mortality of patients requiring ECLS, identify independent predictors associated with mortality and analyze changes of mortality over time.Methods: This retrospective study includes all adult ECLS cases at the University Hospital Zurich, a designated ECLS center in Switzerland, in the period 2007 to 2019.Results: ECLS therapy was required in 679 patients (median age 60 years, 27.5% female). In-hospital mortality was 55.5%. Cubic spline interpolation did not detect evidence for a change in mortality over the whole period of 13 years. In-hospital mortality significantly varied between ECLS indications: 70.7% (152/215) for postcardiotomy, 67.9% (108/159) for cardiopulmonary resuscitation, 47.0% (110/234) for refractory cardiogenic shock, and 9.9% (7/71) for lung transplantation and expansive thoracic surgery (P<0.001). Logistic regression modelling showed excellent discrimination in the receiver operating characteristic (ROC) area under the curve (AUC) of 0.89 [95% confidence interval (CI): 0.87-0.92] and identified significant mortality predictors: age, simplified acute physiology score (SAPS) II, as well as new liver failure and each allogenic blood transfusion unit given per day. ECLS after cardiopulmonary resuscitation was associated with significantly higher mortality compared to ECLS for refractory cardiogenic shock. Conclusions:In-hospital mortality of patients treated with ECLS therapy is high. Outcomes have not changed significantly in the observed period. We identified age, SAPS II, new liver failure and each allogenic blood transfusion unit given per day as independent mortality predictors. Knowledge of predictors strongly associated with in-hospital mortality may affect future decisions about ECLS indications and the respective management to use this elaborate therapy more effectively.

show abstract

“…Furthermore, these authors used different definitions of renal failure. Masha et al defined acute renal failure as serum creatinine increase of more than 1.5 mg/dl with or without renal replacement therapy [36]; Rubino et al as renal impairment requiring continuous renal replacement therapy [37]; and Zhigalov et al as a new renal dysfunction requiring renal replacement therapy or a rise in serum creatinine (greater than three times baseline or greater than 5 mg/dL) [23]. Other authors defined renal failure as an acute kidney injury or organ dysfunction, failing to provide a more detailed definition [35,[38][39][40].…”

Section: Complications and Adverse Events During Va-ecmomentioning

confidence: 99%

Extracorporeal membrane oxygenation for cardiogenic shock: a meta-analysis of mortality and complications

Rajsic

Treml

Jadžić

et al. 2022

Ann. Intensive Care

View full text Add to dashboard Cite

Background Venoarterial extracorporeal membrane oxygenation (va-ECMO) is an advanced life support for critically ill patients with refractory cardiogenic shock. This temporary support bridges time for recovery, permanent assist, or transplantation in patients with high risk of mortality. However, the benefit of this modality is still subject of discussion and despite the continuous development of critical care medicine, severe cardiogenic shock remains associated with high mortality. Therefore, this work aims to analyze the current literature regarding in-hospital mortality and complication rates of va-ECMO in patients with cardiogenic shock. Methods We conducted a systematic review and meta-analysis of the most recent literature to analyze the outcomes of va-ECMO support. Using the PRISMA guidelines, Medline (PubMed) and Scopus (Elsevier) databases were systematically searched up to May 2022. Meta-analytic pooled estimation of publications variables was performed using a weighted random effects model for study size. Results Thirty-two studies comprising 12756 patients were included in the final analysis. Between 1994 and 2019, 62% (pooled estimate, 8493/12756) of patients died in the hospital. More than one-third of patients died during ECMO support. The most frequent complications were renal failure (51%, 693/1351) with the need for renal replacement therapy (44%, 4879/11186) and bleeding (49%, 1971/4523), bearing the potential for permanent injury or death. Univariate meta-regression analyses identified age over 60 years, shorter ECMO duration and presence of infection as variables associated with in-hospital mortality, while the studies reporting a higher incidence of cannulation site bleeding were unexpectedly associated with a reduced in-hospital mortality. Conclusions Extracorporeal membrane oxygenation is an invasive life support with a high risk of complications. We identified a pooled in-hospital mortality of 62% with patient age, infection and ECMO support duration being associated with a higher mortality. Protocols and techniques must be developed to reduce the rate of adverse events. Finally, randomized trials are necessary to demonstrate the effectiveness of va-ECMO in cardiogenic shock.

show abstract

Yellow Means Caution: Correlations Between Liver Injury and Mortality with the Use of VA-ECMO

Cited by 18 publications

References 13 publications

Serum Total Bilirubin With Hospital Survival in Adults During Extracorporeal Membrane Oxygenation

Serum Total Bilirubin With Hospital Survival in Adults During Extracorporeal Membrane Oxygenation

Predictors associated with mortality of extracorporeal life support therapy for acute heart failure: single-center experience with 679 patients

Extracorporeal membrane oxygenation for cardiogenic shock: a meta-analysis of mortality and complications

Contact Info

Product

Resources

About