移植受者ECMO治疗COVID-19呼吸衰竭的结果：一项ELSO登记研究

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2025-09-25 DOI:10.1186/s13054-025-05636-9

Marijke Peetermans, Alexandre Bohyn, Philippe Meersseman, Alexander Wilmer, Joost Wauters, Bart Meyns, Matthias Lubnow, Ann Belmans, Thomas Müller, Alexander P.J. Vlaar, Alain Combes, Greet Hermans

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引用次数: 0

摘要

实体器官移植（SOT）和造血干细胞移植（HSCT）受者中与covid -19相关的呼吸衰竭的ECMO结果描述甚少。我们调查了：(1)移植患者（SOT/HSCT）的COVID-19预后是否比非免疫功能低下（IC）的COVID-19患者差，以及(2)移植受者（SOT/HSCT）中，COVID-19患者的预后是否比非COVID-19相关呼吸衰竭患者差。此外，我们的目的是确定与COVID-19移植中死亡率独立相关的因素。2017年1月1日至2023年7月31日体外生命支持组织注册的回顾性分析。进行两项比较：(1)移植COVID-19与非ic COVID-19，(2)移植COVID-19与移植非COVID-19患者。结果分析使用倾向评分（PS）调整，多变量和PS匹配分析，调整先验确定的混杂因素。主要终点是住院死亡率。在38270例跑步中，移植COVID-19 146例，非ic -COVID-19 12552例，移植非COVID-19 886例。移植COVID-19患者住院死亡率为75.3%,风险总是增加相比non-IC-COVID-19 (PS-adjusted或:2.36(95%置信区间:1.61—-3.46),p < 0.001,多变量或者:2.35(95%置信区间:1.59—-3.49),p < 0.001, PS-matched分析或:1.89(95%置信区间:1.21—-2.95),p < 0.005),移植non-COVID-19患者(PS-adjusted或:4.20(95%置信区间:2.74—-6.44),p < 0.001,多变量或者:3.79(95%置信区间:2.51—-5.74),p < 0.001, PS-matched分析或者:3.17 [95%CI:1.90 ~ 5.28], p < 0.001)。随着时间的推移，死亡率差异保持稳定。年龄越大，死亡率越高。与非ic - covid -19患者相比，这伴随着更高的肾脏替代治疗需求。与非covid -19移植患者相比，ECMO运行和生存出院时间无一例外地延长。出血性、代谢性、肺部和感染性并发症的发生率一贯较高。COVID-19移植ECMO患者的死亡率很高，因此在这一人群中谨慎使用ECMO。

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Outcomes of transplant recipients on ECMO for COVID-19 respiratory failure: an ELSO registry study

ECMO outcomes in COVID-19-related respiratory failure among solid organ transplant (SOT) and hematopoietic stem-cell transplant recipients (HSCT) are poorly described. We investigated: (1) whether transplant patients (SOT/HSCT) with COVID-19 have worse outcomes than non-immunocompromised (IC) COVID-19 patients, and (2) whether among transplant recipients (SOT/HSCT), those with COVID-19 have worse outcomes than those with non-COVID-19-related respiratory failure. Additionally, we aimed to identify factors independently associated with mortality among COVID-19 transplants. Retrospective analyses of the Extracorporeal Life Support Organization Registry from 1/1/2017 to 31/07/2023. Two comparisons were made: (1) transplant COVID-19 versus non-IC COVID-19, and (2) transplant COVID-19 versus transplant non-COVID-19 patients. Outcomes were analyzed using propensity score (PS)-adjusted, multivariable, and PS-matched analyses, adjusting for a priori identified confounders. Primary outcome was in-hospital mortality. Among 38,270 runs, 146 transplant COVID-19, 12,552 non-IC-COVID-19 and 886 transplant non-COVID-19 runs were identified. In-hospital mortality in transplant COVID-19 patients was 75.3% and the risk was invariably increased compared to non-IC-COVID-19 (PS-adjusted OR: 2.36 [95%CI:1.61–3.46], p < 0.001, multivariable OR:2.35 [95%CI:1.59–3.49], p < 0.001, and PS-matched analysis OR: 1.89 [95%CI:1.21–2.95], p < 0.005) and transplant non-COVID-19 patients (PS-adjusted OR: 4.20 [95%CI:2.74–6.44], p < 0.001, multivariable OR: 3.79 [95%CI:2.51–5.74], p < 0.001, and PS-matched analyses OR: 3.17 [95%CI:1.90–5.28], p < 0.001). Mortality difference remained stable over time. Older age independently associated with higher mortality. This was accompanied by higher need for renal replacement therapy compared to non-IC-COVID-19 patients. Compared to transplant non-COVID-19 patients, ECMO runs and time-to-live discharge were invariably prolonged. Hemorrhagic, metabolic, pulmonary and infectious complications consistently occurred more frequently. Mortality was high in COVID-19 transplant ECMO patients, warranting cautious use of ECMO in this population.

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.