比较四种重症监护评分对静脉-动脉 ECMO 术后预后的影响:单中心回顾性研究

Suraj Sudarsanan, Praveen Sivadasan, Prem Chandra, Amr S Omar, Kathy Lynn Gaviola Atuel, Hafeez Ulla Lone, Hany Osman Elsayed Ragab, Irshad Ehsan, Cornelia Sonia Carr, Abdul Rasheed Pattath, Abdulaziz Al Khulaifi, Yasser Mahfouz Eltokhy Shouman, Abdulwahid Al Mulla
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引用次数: 0

摘要

背景:评估APACHE II(急性生理学和慢性健康评估II)、SOFA(连续器官衰竭评估评分)、心脏手术评分(CASUS)和SAVE(VA-ECMO(VA-ECMO)术后生存率)预测接受静脉-动脉ECMO(VA-ECMO)患者队列的预后能力:对 2015 年至 2022 年期间接受 VA-ECMO 插管后入住心胸重症监护室(CTICU)至少 24 小时的所有患者进行观察性回顾研究。APACHE II、SOFA和CASUS评分在ICU入院后24小时计算。SAVE评分根据插入ECMO后24小时内最后一次获得的患者详细资料计算。与研究相关的人口统计学、临床和实验室数据均来自电子病历:结果:ECMO 前血清中的乳酸盐和肌酐水平与死亡率显著相关。在 ECMO 插管后 4 小时和 12 小时,较低的 ECMO 流速与出院存活率显著相关。在接受 ECMO 治疗期间出现心律失常、急性肾损伤 (AKI) 以及需要持续肾脏替代治疗 (CRRT) 与死亡率密切相关。重症监护室入院 24 小时时计算的 APACHE-II、SOFA 和 CASUS 在非存活者中明显较高。使用 ROC 曲线分析法对风险评分进行分类后发现,在插入 ECMO 后入住 ICU 24 小时时计算的 APACHE-II、SOFA 和 CASUS 对死亡率的预测能力适中,而 SAVE 评分则无法预测死亡率。在插入 ECMO 后入住 ICU 24 小时时计算的 APACHE-II >27(AUC 为 0.66)对死亡率的预测能力最强。对四项评分的多变量逻辑回归分析表明,在插入 ECMO 后入住 ICU 24 小时时计算的 APACHE-II 27 和 SOFA 14 对死亡率有显著的独立预测作用:结论:与存活者相比,非存活者在入住重症监护室 24 小时时的 APACHE-II、SOFA 和 CASUS 评分明显较高。APACHE-II 对死亡率的预测能力最强。在 ECMO 插管后进入 ICU 24 小时时,APACHE-II 得分达到或超过 27 分,SOFA 达到或超过 14 分,可预测死亡率,并有助于医生做出决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of four intensive care scores in prediction of outcome after Veno-Arterial ECMO: A single center retrospective study
Background: Assess the ability of APACHE II (acute physiology and chronic health evaluation II), SOFA (sequential organ failure assessment scores), Cardiac Surgery Score (CASUS) and SAVE (Survival after VA-ECMO) to predict outcomes in a cohort of patients undergoing Veno-Arterial ECMO (VA-ECMO) Methods: Observational retrospective study of all patients admitted to Cardiothoracic Intensive Care Unit (CTICU) for a minimum duration of 24 hours after undergoing VA-ECMO insertion between years 2015 to 2022. Scores for APACHE II, SOFA and CASUS were calculated at 24 after ICU admission. SAVE score was calculated from the last available patient details within 24 hours of ECMO insertion. Demographic, clinical, and laboratory data relevant for the study was retrieved from electronic patient records. Results: Pre-ECMO serum levels of lactates and creatinine were significantly associated with mortality. Lower ECMO flow rates at 4 hours and 12 hours after ECMO cannulation was significantly associated with survival to discharge. Development of arrythmias, acute kidney injury (AKI) and need of continuous renal replacement therapy (CRRT) while on ECMO were significantly associated with mortality. The APACHE-II, SOFA and CASUS, calculated at 24 hours of ICU admission were significantly higher amongst non-survivors. Following categorization of risk scores using ROC curve analysis, it was found that APACHE-II, SOFA and CASUS calculated at 24 hours of ICU admission after ECMO insertion demonstrated moderate predictive ability for mortality whereas SAVE score failed to predict mortality. APACHE-II >27 (AUC of 0.66) calculated at 24 hours of ICU admission after ECMO insertion, demonstrated the greatest predictive ability, for mortality. Multivariate logistic regression analysis of the four scores showed that APACHE-II > 27 and SOFA > 14 calculated at 24 hours of ICU admission after ECMO insertion, were independently significantly predictive of mortality Conclusions: The APACHE-II, SOFA and CASUS, calculated at 24 hours of ICU admission were significantly higher amongst non-survivors as compared to survivors. APACHE-II demonstrated the best mortality predictive ability. APACHE-II scores of 27 or above, and SOFA of 14 or above at 24 hours of ICU admission after ECMO cannulation can predict mortality and will aid physicians in decision making
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