Fibrinogen–Albumin-Ratio is an independent predictor of thromboembolic complications in patients undergoing VA-ECMO

AbstractVeno-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.

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Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up

Medicina ◽

10.3390/medicina57080747 ◽

2021 ◽

Vol 57 (8) ◽

pp. 747

Author(s):

Rafal Berger ◽

Hasan Hamdoun ◽

Rodrigo Sandoval Boburg ◽

Medhat Radwan ◽

Metesh Acharya ◽

...

Keyword(s):

Quality Of Life ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Ecmo Support ◽

Circulatory Support ◽

Significant Difference ◽

Va Ecmo ◽

Ecmo Therapy

Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.

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Galectin-3 in Critically Ill Patients with Sepsis and/or Trauma: A Good Predictor of Outcome or Not?

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2018-0037 ◽

2018 ◽

Vol 0 (0) ◽

Author(s):

Jasna Jevdjic ◽

Maja Surbatovic ◽

Snezana Milosavljevic ◽

Goran Rondovic ◽

Ivan Stanojevic ◽

...

Keyword(s):

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Good Predictor ◽

Injury Severity ◽

Area Under The Curve ◽

University Hospital ◽

Youden Index ◽

Lethal Outcome ◽

Galectin 3

Abstract Severe sepsis and/or trauma complicated with multiple organ dysfunction syndrome are leading causes of death in critically ill patients. The aim of this prospective, observational, single centre study was to assess the prognostic value of galectin-3 regarding outcome in critically ill patients with severe trauma and/or severe sepsis. The outcome measure was hospital mortality. In total, 75 critically ill patients who were admitted to the intensive care unit of the tertiary university hospital were enrolled in a prospective observational study. Blood samples were collected upon fulfilling Sepsis-3 criteria and for a traumatized Injury Severity Score > 25 points. Levels of galectin-3 were significantly higher in nonsurvivors on the day of enrolment - Day 1 (p<0.05). On Day 1, the area under the curve (AUC) for the galectin-3 for lethal outcome was 0.602. At a cut-off level of 262.82 ng/mL, the sensitivity was 53%, and the specificity was 69.7%, which was objectively determined by a Youden index of 0.20. The discriminative power of galectin-3 in predicting outcome was statistically significant. Galectin-3 on Day 1 is a fairly good predictor of lethal outcome.

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Effectiveness of mid-regional pro-adrenomedullin (MR-proADM) as prognostic marker in COVID-19 critically ill patients: An observational prospective study

PLoS ONE ◽

10.1371/journal.pone.0246771 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246771

Author(s):

Giorgia Montrucchio ◽

Gabriele Sales ◽

Francesca Rumbolo ◽

Filippo Palmesino ◽

Vito Fanelli ◽

...

Keyword(s):

Cardiovascular Disease ◽

Area Under The Curve ◽

Predictive Ability ◽

University Hospital ◽

Rank Test ◽

Operating Characteristics ◽

Icu Patients ◽

Dying Patients ◽

D Dimer ◽

Over Time

Objective To test the effectiveness of mid-regional pro-adrenomedullin (MR-proADM) in comparison to C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH) in predicting mortality in COVID-19-ICU-patients. Methods All consecutive COVID-19 adult patients admitted between March and June 2020 to the ICU of a referral, university hospital in Northern-Italy were enrolled. MR-proADM and routine laboratory test were measured within 48 hours from ICU admission, on day 3, 7 and 14. Survival curves difference with MR-proADM cut-off set to 1.8 nmol/L were tested using log-rank test. Predictive ability was compared using area under the curve and 95% confidence interval of different receiver-operating characteristics curves. Results 57 patients were enrolled. ICU and overall mortality were 54.4%. At admission, lymphocytopenia was present in 86% of patients; increased D-dimer and CRP levels were found in 84.2% and 87.7% of patients respectively, while PCT values > 0.5 μg/L were observed in 47.4% of patients. MR-proADM, CRP and LDH were significantly different between surviving and non-surviving patients and over time, while PCT, D-dimer and NT-pro-BNP did not show any difference between the groups and over time; lymphocytes were different between surviving and non-surviving patients only. MR-proADM was higher in dying patients (2.65±2.33vs1.18±0.47, p<0.001) and a higher mortality characterized patients with MR-proADM >1.8 nmol/L (p = 0.016). The logistic regression model adjusted for age, gender, cardiovascular disease, diabetes mellitus and PCT values confirmed an odds ratio = 10.3 [95%CI:1.9–53.6] (p = 0.006) for MR-proADM >1.8 nmol/L and = 22.2 [95%CI:1.6–316.9] (p = 0.022) for cardiovascular disease. Overall, MR-proADM had the best predictive ability (AUC = 0.85 [95%CI:0.78–0.90]). Conclusions In COVID-19 ICU-patients, MR-proADM seems to have constantly higher values in non-survivor patients and predict mortality more precisely than other biomarkers. Repeated MR-proADM measurement may support a rapid and effective decision-making. Further studies are needed to better explain the mechanisms responsible of the increase in MR-proADM in COVID-19 patients.

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Defining Minor Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000515169 ◽

2021 ◽

pp. 1-8

Author(s):

Alejandra Gómez-González ◽

Uxue Lazcano ◽

Rosa Maria Vivanco-Hidalgo ◽

Luis Prats-Sánchez ◽

Daniel Guisado-Alonso ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

External Validation ◽

Area Under The Curve ◽

Cutoff Point ◽

University Hospital ◽

Minor Stroke ◽

Operating Characteristics ◽

Discovery Cohort ◽

Definition Of ◽

A Minor

Background and Purpose: The minor stroke concept has not been analyzed in intracerebral hemorrhage (ICH) patients. Our purpose was to determine the optimal cut point on the NIH Stroke Scale (NIHSS) for defining a minor ICH (mICH) in patients with primary ICH. Methods: An ICH was considered minor if associated with a favorable 3-month outcome (modified Rankin Scale score ≤2). For supratentorial ICH, the discovery cohort consisted of 478 patients prospectively admitted at University Hospital del Mar. Association between NIHSS at admission and 3-month outcome was evaluated with area under the curve-receiver operating characteristics (AUC-ROC) and Youden’s index to identify the optimal NIHSS cutoff point to define mICH. External validation was performed in a cohort of 242 supratentorial ICH patients from University Hospital Sant Pau. For infratentorial location, patients from both hospitals (n = 85) were analyzed together. Results: The best NIHSS cutoff point defining supratentorial-mICH was 6 (AUC-ROC = 0.815 [0.774–0.857] in the discovery cohort and AUC-ROC = 0.819 [0.756–0.882] in the external validation cohort). For infratentorial ICH, the best cutoff point was 4 (AUC-ROC = 0.771 [0.664–0.877]). Using these cutoff points, 40.5% of all primary ICH cases were mICH. Of these, 70.2% were living independently at 3-month follow-up (72% for supratentorial ICH and 56.1% for infratentorial ICH) and 6.5% had died (5.3% for supratentorial ICH, and 14.6% for infratentorial ICH). For patients identified as non-mICH, good 3-month outcome was observed in 11.3% of cases; mortality was 51%. Conclusions: The definition of mICH using the NIHSS cutoff point of 6 for supratentorial ICH and 4 for infratentorial ICH is useful to identify good outcome in ICH patients.

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Risk Scores in ST-Segment Elevation Myocardial Infarction Patients with Refractory Cardiogenic Shock and Veno-Arterial Extracorporeal Membrane Oxygenation

Journal of Clinical Medicine ◽

10.3390/jcm10050956 ◽

2021 ◽

Vol 10 (5) ◽

pp. 956

Author(s):

Carl Semaan ◽

Arthur Charbonnier ◽

Jeremy Pasco ◽

Walid Darwiche ◽

Christophe Saint Etienne ◽

...

Keyword(s):

Myocardial Infarction ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Risk Scores ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Refractory Cardiogenic Shock ◽

St Segment ◽

Va Ecmo ◽

Ecmo Therapy

Although many risk models have been tested in patients implanted by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), few scores assessed patients’ prognosis in the setting of ST-segment elevation myocardial infarction (STEMI) with refractory cardiogenic shock. We aimed at assessing the performance of risk scores, notably the prEdictioN of Cardiogenic shock OUtcome foR AMI patients salvaGed by VA-ECMO (ENCOURAGE) score, for predicting mortality in this particular population. This retrospective observational study included patients admitted to Tours University Hospital for STEMI with cardiogenic shock and requiring hemodynamic support by VA-ECMO. Among the fifty-one patients, the 30-day and 6-month survival rates were 63% and 56% respectively. Thirty days after VA-ECMO therapy, probabilities of mortality were 12, 17, 33, 66, 80% according to the ENCOURAGE score classes 0–12, 13–18, 19–22, 23–27, and ≥28, respectively. The ENCOURAGE score (AUC of the Receiving Operating Characteristic curve = 0.83) was significantly better compared to other risk scores. The hazard ratio for survival at 30 days for each point of the ENCOURAGE score was 1.10 (CI 95% (1.06, 1.15); p < 0.001). Decision curve analysis indicated that the ENCOURAGE score had the best clinical usefulness of the tested risk scores and the Hosmer–Lemeshow test suggested an accurate calibration. Our data suggest that the ENCOURAGE score is valid and the most relevant score to predict 30-day mortality after VA-ECMO therapy in STEMI patients with refractory cardiogenic shock. It may help decision-making teams to better select STEMI patients with shock for VA-ECMO therapy.

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Time-to-Death Longitudinal Characterization of Clinical Variables and Longitudinal Prediction of Mortality in COVID-19 Patients: A Two-Center Study

Frontiers in Medicine ◽

10.3389/fmed.2021.661940 ◽

2021 ◽

Vol 8 ◽

Author(s):

Anne Chen ◽

Zirun Zhao ◽

Wei Hou ◽

Adam J. Singer ◽

Haifang Li ◽

...

Keyword(s):

Predictive Model ◽

White Blood Cells ◽

Area Under The Curve ◽

University Hospital ◽

Clinical Markers ◽

Operating Characteristics ◽

Hospital Data ◽

Temporal Characteristics ◽

Clinical Variables ◽

Prediction Of Mortality

Objectives: To characterize the temporal characteristics of clinical variables with time lock to mortality and build a predictive model of mortality associated with COVID-19 using clinical variables.Design: Retrospective cohort study of the temporal characteristics of clinical variables with time lock to mortality.Setting: Stony Brook University Hospital (New York) and Tongji Hospital.Patients: Patients with confirmed positive for severe acute respiratory syndrome coronavirus-2 using polymerase chain reaction testing. Patients from the Stony Brook University Hospital data were used for training (80%, N = 1,002) and testing (20%, N = 250), and 375 patients from the Tongji Hospital (Wuhan, China) data were used for testing.Intervention: None.Measurements and Main Results: Longitudinal clinical variables were analyzed as a function of days from outcome with time-lock-to-day of death (non-survivors) or discharge (survivors). A predictive model using the significant earliest predictors was constructed. Performance was evaluated using receiver operating characteristics area under the curve (AUC). The predictive model found lactate dehydrogenase, lymphocytes, procalcitonin, D-dimer, C-reactive protein, respiratory rate, and white-blood cells to be early predictors of mortality. The AUC for the zero to 9 days prior to outcome were: 0.99, 0.96, 0.94, 0.90, 0.82, 0.75, 0.73, 0.77, 0.79, and 0.73, respectively (Stony Brook Hospital), and 1.0, 0.86, 0.88, 0.96, 0.91, 0.62, 0.67, 0.50, 0.63, and 0.57, respectively (Tongji Hospital). In comparison, prediction performance using hospital admission data was poor (AUC = 0.59). Temporal fluctuations of most clinical variables, indicative of physiological and biochemical instability, were markedly higher in non-survivors compared to survivors (p < 0.001).Conclusion: This study identified several clinical markers that demonstrated a temporal progression associated with mortality. These variables accurately predicted death within a few days prior to outcome, which provides objective indication that closer monitoring and interventions may be needed to prevent deterioration.

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Extracorporeal Life Support for Cardiac Arrest and Cardiogenic Shock

US Cardiology Review ◽

10.15420/usc.2021.13 ◽

2021 ◽

Vol 15 ◽

Author(s):

Andrea Elliott ◽

Garima Dahyia ◽

Rajat Kalra ◽

Tamas Alexy ◽

Jason Bartos ◽

...

Keyword(s):

Cardiac Arrest ◽

Intensive Care ◽

Cardiogenic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

The Body ◽

Rising Incidence ◽

Va Ecmo ◽

Technical Principles ◽

Ecmo Therapy

The rising incidence and recognition of cardiogenic shock has led to an increase in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). As clinical experience with this therapy has increased, there has also been a rapid growth in the body of observational and randomized data describing the clinical and logistical considerations required to institute a VA-ECMO program with successful clinical outcomes. The aim of this review is to summarize this contemporary data in the context of four key themes that pertain to VA-ECMO programs: the principles of patient selection; basic hemodynamic and technical principles underlying VA-ECMO; contraindications to VA-ECMO therapy; and common complications and intensive care considerations that are encountered in the setting of VA-ECMO therapy.

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Successful Treatment of Severe Myocardial Injury Complicated With Refractory Cardiogenic Shock Caused by AOPP Using Extracorporeal Membrane Oxygenation

10.21203/rs.3.rs-104375/v1 ◽

2020 ◽

Author(s):

Yang Li ◽

ChunShui Cao ◽

XiaoLong Luo ◽

Liang Huang

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Myocardial Injury ◽

Cardiac Toxicity ◽

Organophosphorus Pesticide ◽

Pesticide Poisoning ◽

Membrane Oxygenation ◽

Refractory Cardiogenic Shock ◽

Va Ecmo ◽

Ecmo Therapy

Abstract Acute organophosphorus pesticide poisoning (AOPP) is a common critical illness observed in clinical practice, and severe AOPP can cause serious cardiac toxicity. We report a case of severe myocardial injury caused by AOPP complicated with refractory cardiogenic shock that was successfully rescued with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy. We suggest that for patients with severe myocardial injury complicated with cardiogenic shock following AOPP, the use of VA-ECMO therapy can improve the prognosis.

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Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

Mediterranean Journal of Emergency Medicine & Acute Care ◽

10.52544/2642-7184(1)1001 ◽

2019 ◽

Vol 1 (1) ◽

pp. 13-21

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Imaging Modality ◽

Low Cost ◽

Tertiary Care ◽

Area Under The Curve ◽

Final Diagnosis ◽

University Hospital ◽

Operating Characteristics ◽

Early Assessment

Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining of acute abdominal pain in a tertiary care university hospital in Italy. Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU. Results: A total number of 230 patients with acute non-traumatic abdominal pain were enrolled. Overall agreement between routine standard imaging and BPU turned out to be equal for computed tomography (K=0.3) and traditional ultrasound (K=0.29). Receiver operating characteristics curve (ROC) analysis for diagnostic power of the BPU in comparison with traditional US showed an area under the curve of 0.65, sensitivity and specificity of 87.2% and 42.31% respectively. Conclusions: Emergency use of BPU in patients with non-traumatic abdominal pain demonstrated good diagnostic performance when compared to traditional imaging, with the potential advantage of reducing costs and delay in patient final disposition.

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Neutrophil-lymphoycyte-ratio, platelet-lymphocyte-ratio and procalcitonin for early assessment of prognosis in patients undergoing VA-ECMO

Scientific Reports ◽

10.1038/s41598-021-04519-7 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Sebastian Roth ◽

René M’Pembele ◽

Alexandra Stroda ◽

Catrin Jansen ◽

Giovanna Lurati Buse ◽

...

Keyword(s):

Hospital Mortality ◽

Area Under The Curve ◽

Final Analysis ◽

Operating Characteristics ◽

Early Assessment ◽

Discriminative Ability ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Va Ecmo

AbstractThe 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.

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