Franziska Fuchs, Clemens Wiest, Alois Philipp, Maik Foltan, Roland Schneckenpointner, Alexander Dietl, Dirk Lunz, Christoph Fisser, Thomas Müller, Matthias Lubnow
{"title":"静脉-静脉体外膜氧合患者急性肾损伤：危险因素和结果的回顾性观察分析。","authors":"Franziska Fuchs, Clemens Wiest, Alois Philipp, Maik Foltan, Roland Schneckenpointner, Alexander Dietl, Dirk Lunz, Christoph Fisser, Thomas Müller, Matthias Lubnow","doi":"10.34067/KID.0000000920","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>AKI is a frequent concomitant organ failure during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study investigated the prevalence and the impact of AKI on survival to hospital discharge and up to 365 days after discharge, and risk-factors for developing AKI during VV-ECMO.</p><p><strong>Methods: </strong>This is an observational retrospective study of 500 consecutive patients receiving VV-ECMO between November 2014 and December 2021. Patients were divided into three groups: 1)AKI onset before ECMO 2)AKI onset during ECMO 3)AKI onset before and new onset during ECMO. Kidney Disease: Improving Global Outcomes (KDIGO) definition was used to define AKI. Follow-up was 365 days after hospital discharge. Propensity-score-matching was performed for patients without AKI and patients with AKI onset during ECMO to analyse risk-factors for AKI onset during VV-ECMO.</p><p><strong>Results: </strong>320 patients (64.0%) had AKI, 182 (36.4%) with onset before ECMO and 158 (31.6%) with onset during ECMO. At ECMO-initiation, patients with AKI onset before VV-ECMO presented significantly higher inflammatory markers and higher norepinephrine dosage, while patients developing AKI during VV-ECMO did not differ from those without AKI. Survival to hospital discharge was 67.0% (AKI: 60.9%, No-AKI: 77.8%, p<0.001). Cox-regression-analysis revealed AKI KDIGO-stage 3, independent from onset, as independent risk-factor for reduced survival to hospital discharge (HR 2.15, 95% CI: 1.37-3.37, p=0.001). During follow-up, survival was 92.5%; age was shown as the sole risk-factor for reduced survival in hospital survivors in the multivariate-logistic-regression-model. In the propensity-score-matched cohort (41 patients in each group), the AKI-group had lower MAP and significantly higher CRP levels the days before AKI. Factors associated with VV-ECMO support (blood-flow, cell-free haemoglobin) did not differ.</p><p><strong>Conclusions: </strong>Severe AKI is associated with reduced hospital survival, regardless of whether it occurs before or during ECMO. AKI onset during VV-ECMO is less due to ECMO-related factors than to recurrent septic episodes.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute Kidney Injury in Patients With Veno-venous Extracorporeal Membrane Oxygenation: An Observational Retrospective Analysis of Risk-factors and Outcome.\",\"authors\":\"Franziska Fuchs, Clemens Wiest, Alois Philipp, Maik Foltan, Roland Schneckenpointner, Alexander Dietl, Dirk Lunz, Christoph Fisser, Thomas Müller, Matthias Lubnow\",\"doi\":\"10.34067/KID.0000000920\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>AKI is a frequent concomitant organ failure during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study investigated the prevalence and the impact of AKI on survival to hospital discharge and up to 365 days after discharge, and risk-factors for developing AKI during VV-ECMO.</p><p><strong>Methods: </strong>This is an observational retrospective study of 500 consecutive patients receiving VV-ECMO between November 2014 and December 2021. Patients were divided into three groups: 1)AKI onset before ECMO 2)AKI onset during ECMO 3)AKI onset before and new onset during ECMO. Kidney Disease: Improving Global Outcomes (KDIGO) definition was used to define AKI. Follow-up was 365 days after hospital discharge. Propensity-score-matching was performed for patients without AKI and patients with AKI onset during ECMO to analyse risk-factors for AKI onset during VV-ECMO.</p><p><strong>Results: </strong>320 patients (64.0%) had AKI, 182 (36.4%) with onset before ECMO and 158 (31.6%) with onset during ECMO. At ECMO-initiation, patients with AKI onset before VV-ECMO presented significantly higher inflammatory markers and higher norepinephrine dosage, while patients developing AKI during VV-ECMO did not differ from those without AKI. Survival to hospital discharge was 67.0% (AKI: 60.9%, No-AKI: 77.8%, p<0.001). Cox-regression-analysis revealed AKI KDIGO-stage 3, independent from onset, as independent risk-factor for reduced survival to hospital discharge (HR 2.15, 95% CI: 1.37-3.37, p=0.001). During follow-up, survival was 92.5%; age was shown as the sole risk-factor for reduced survival in hospital survivors in the multivariate-logistic-regression-model. In the propensity-score-matched cohort (41 patients in each group), the AKI-group had lower MAP and significantly higher CRP levels the days before AKI. Factors associated with VV-ECMO support (blood-flow, cell-free haemoglobin) did not differ.</p><p><strong>Conclusions: </strong>Severe AKI is associated with reduced hospital survival, regardless of whether it occurs before or during ECMO. AKI onset during VV-ECMO is less due to ECMO-related factors than to recurrent septic episodes.</p>\",\"PeriodicalId\":17882,\"journal\":{\"name\":\"Kidney360\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney360\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.34067/KID.0000000920\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney360","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.34067/KID.0000000920","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Acute Kidney Injury in Patients With Veno-venous Extracorporeal Membrane Oxygenation: An Observational Retrospective Analysis of Risk-factors and Outcome.
Background: AKI is a frequent concomitant organ failure during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study investigated the prevalence and the impact of AKI on survival to hospital discharge and up to 365 days after discharge, and risk-factors for developing AKI during VV-ECMO.
Methods: This is an observational retrospective study of 500 consecutive patients receiving VV-ECMO between November 2014 and December 2021. Patients were divided into three groups: 1)AKI onset before ECMO 2)AKI onset during ECMO 3)AKI onset before and new onset during ECMO. Kidney Disease: Improving Global Outcomes (KDIGO) definition was used to define AKI. Follow-up was 365 days after hospital discharge. Propensity-score-matching was performed for patients without AKI and patients with AKI onset during ECMO to analyse risk-factors for AKI onset during VV-ECMO.
Results: 320 patients (64.0%) had AKI, 182 (36.4%) with onset before ECMO and 158 (31.6%) with onset during ECMO. At ECMO-initiation, patients with AKI onset before VV-ECMO presented significantly higher inflammatory markers and higher norepinephrine dosage, while patients developing AKI during VV-ECMO did not differ from those without AKI. Survival to hospital discharge was 67.0% (AKI: 60.9%, No-AKI: 77.8%, p<0.001). Cox-regression-analysis revealed AKI KDIGO-stage 3, independent from onset, as independent risk-factor for reduced survival to hospital discharge (HR 2.15, 95% CI: 1.37-3.37, p=0.001). During follow-up, survival was 92.5%; age was shown as the sole risk-factor for reduced survival in hospital survivors in the multivariate-logistic-regression-model. In the propensity-score-matched cohort (41 patients in each group), the AKI-group had lower MAP and significantly higher CRP levels the days before AKI. Factors associated with VV-ECMO support (blood-flow, cell-free haemoglobin) did not differ.
Conclusions: Severe AKI is associated with reduced hospital survival, regardless of whether it occurs before or during ECMO. AKI onset during VV-ECMO is less due to ECMO-related factors than to recurrent septic episodes.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
