[논문]Prediction of 6-Month Mortality Using Pre-Extracorporeal Membrane Oxygenation Lactate in Patients with Acute Coronary Syndrome Undergoing Veno-Arterial-Extracorporeal Membrane Oxygenation

Kim, Eunchong; Sodirzhon-Ugli, Nodirbek Yuldashev; Kim, Do Wan; Lee, Kyo Seon; Lim, Yonghwan; Kim, Min-Chul; Cho, Yong Soo; Jung, Yong Hun; Jeung, Kyung Woon; Cho, Hwa Jin; Jeong, In Seok

doi:10.5090/jcs.21.127

[국내논문] Prediction of 6-Month Mortality Using Pre-Extracorporeal Membrane Oxygenation Lactate in Patients with Acute Coronary Syndrome Undergoing Veno-Arterial-Extracorporeal Membrane Oxygenation 원문보기

Journal of chest surgery, v.55 no.2, 2022년, pp.143 - 150

Kim, Eunchong (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) , Sodirzhon-Ugli, Nodirbek Yuldashev (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) , Kim, Do Wan (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) , Lee, Kyo Seon (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) , Lim, Yonghwan (Department of Cardiology, Chonnam National University Medical School) , Kim, Min-Chul (Department of Cardiology, Chonnam National University Medical School) , Cho, Yong Soo (Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School) , Jung, Yong Hun (Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School) , Jeung, Kyung Woon (Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School) , Cho, Hwa Jin , Jeong, In Seok

Abstract ▼ AI-Helper

Background: The effectiveness of extracorporeal membrane oxygenation (ECMO) for patients with refractory cardiogenic shock or cardiac arrest is being established, and serum lactate is well known as a biomarker of end-organ perfusion. We evaluated the efficacy of pre-ECMO lactate for predicting 6-month survival in patients with acute coronary syndrome (ACS) undergoing ECMO. Methods: We reviewed the medical records of 148 patients who underwent veno-arterial (VA) ECMO for ACS between January 2015 and June 2020. These patients were divided into survivors and non-survivors based on 6-month survival. All clinical data before and during ECMO were compared between the 2 groups. Results: Patients' mean age was 66.0±10.5 years, and 116 (78.4%) were men. The total survival rate was 45.9% (n=68). Cox regression analysis showed that the pre-ECMO lactate level was an independent predictor of 6-month mortality (hazard ratio, 1.210; 95% confidence interval [CI], 1.064-1.376; p=0.004). The area under the receiver operating characteristic curve of pre-ECMO lactate was 0.64 (95% CI, 0.56-0.72; p=0.002; cut-off value=9.8 mmol/L). Kaplan-Meier survival analysis showed that the cumulative survival rate at 6 months was significantly higher among patients with a pre-ECMO lactate level of 9.8 mmol/L or less than among those with a level exceeding 9.8 mmol/L (57.3% vs. 31.8%, p=0.0008). Conclusion: A pre-ECMO lactate of 9.8 mmol/L or less may predict a favorable outcome at 6 months in ACS patients undergoing VA-ECMO. Further research aiming to improve the accuracy of predictions of reversibility in patients with high pre-ECMO lactate levels is essential.

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표/그림 (7)

표 Table 1. Patients' characteristics before ECMO support and a comparison between survivors and non-survivors defined in terms of 6-month mortality
표 Table 2. Analysis of clinical information related to coronary revascularization during ECMO support
표 Table 3. Comparison of ECMO outcomes between survivors and non-survivors defined in terms of 6-month mortality
그림 Fig. 1. Receiver operating characteristic (ROC) curve of pre-extracorporeal membrane oxygenation (ECMO) lactate levels for the prediction of 6-month mortality. The area under the ROC curve of pre-ECMO lactate levels was 0.64 (standard error=0.05; 95% confidence interval, 0.56-0.72; p=0.002, cut-off value=9.8 mmol/L). AUC, area under ROC curve.
표 Table 4. Cox proportional-hazards regression with pre-ECMO covariates based on 6-month mortality
그림 Fig. 2. Comparison of receiver operating characteristic (ROC) curves between pre-extracorporeal membrane oxygenation (ECMO) lactate levels and Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) scores for the prediction of 6-month mortality with and without extracorporeal cardiopulmonary resuscitation (ECPR). (A) Comparison of ROC curves in all patients (difference between areas=0.06; standard error [SE]=0.06; 95% confidence interval [CI], 0.06-0.17; p=0.342). (B) Comparison of ROC curves in non-ECPR patients (difference between areas=0.03; SE=0.08; 95% CI, 0.13-0.20; p=0.643). (C) Comparison of ROC curves in ECPR patients (difference between areas=0.2; SE=0.09; 95% CI, 0.02-0.38; p=0.031). AUC, area under ROC curve.
그림 Fig. 3. Survival analysis with cumulative mortality incidence from the time of extracorporeal membrane oxygenation (ECMO) initiation. Patients with pre-ECMO lactate levels of more than 9.8 mmol/L had a lower survival probability (p<0.0008) than patients with pre-ECMO lactate levels of less than 9.8 mmol/L.

참고문헌 (19)

1 Vahdatpour C Collins D Goldberg S 2019 Cardiogenic shock J Am Heart Assoc 8 e011991 10.1161/JAHA.119.011991 30947630

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2 Ponikowski P Voors AA Anker SD 2016 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC Eur Heart J 37 2129 200 10.1093/eurheartj/ehw128 27206819

상세보기
3 Riebandt J Haberl T Mahr S 2014 Preoperative patient optimization using extracorporeal life support improves outcomes of INTERMACS level I patients receiving a permanent ventricular assist device Eur J Cardiothorac Surg 46 486 92 10.1093/ejcts/ezu093 24648428

상세보기
4 Schmidt M Burrell A Roberts L 2015 Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score Eur Heart J 36 2246 56 10.1093/eurheartj/ehv194 26033984

상세보기
5 Garcia-Alvarez M Marik P Bellomo R 2014 Sepsis-associated hyperlactatemia Crit Care 18 503 10.1186/s13054-014-0503-3 25394679

상세보기
6 Dellinger RP Levy MM Rhodes A 2013 Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012 Intensive Care Med 39 165 228 10.1007/s00134-012-2769-8 23361625

상세보기
7 Sterling SA Puskarich MA Shapiro NI 2013 Characteristics and outcomes of patients with vasoplegic versus tissue dysoxic septic shock Shock 40 11 4 10.1097/SHK.0b013e318298836d 23649098

상세보기
8 Jansen TC van Bommel J Bakker J 2009 Blood lactate monitoring in critically ill patients: a systematic health technology assessment Crit Care Med 37 2827 39 10.1097/00003246-200910000-00022 19707124

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9 Kim DW Cho HJ Kim GS 2018 Predictive value of procalcitonin for infection and survival in adult cardiogenic shock patients treated with extracorporeal membrane oxygenation Chonnam Med J 54 48 54 10.4068/cmj.2018.54.1.48 29399566

상세보기
10 Thiele H Akin I Sandri M 2017 PCI strategies in patients with acute myocardial infarction and cardiogenic shock N Engl J Med 377 2419 32 10.1056/NEJMoa1710261 29083953

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11 Thiele H Akin I Sandri M 2018 One-year outcomes after PCI strategies in cardiogenic shock N Engl J Med 379 1699 710 10.1056/NEJMoa1808788 30145971

상세보기
12 Lorusso R Shekar K MacLaren G 2021 ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients ASAIO J 67 827 44 10.1097/MAT.0000000000001510 34339398

상세보기
13 Vasques F Romitti F Gattinoni L Camporota L 2019 How I wean patients from veno-venous extra-corporeal membrane oxygenation Crit Care 23 316 10.1186/s13054-019-2592-5 31533848

상세보기
14 Chen WC Huang KY Yao CW 2016 The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department Crit Care 20 336 10.1186/s13054-016-1520-1 27769308

상세보기
15 Broder G Weil MH 1964 Excess lactate: an index of reversibility of shock in human patients Science 143 1457 9 10.1126/science.143.3613.1457 14107454

상세보기
16 Luft D Deichsel G Schmülling RM Stein W Eggstein M 1983 Definition of clinically relevant lactic acidosis in patients with internal diseases Am J Clin Pathol 80 484 9 10.1093/ajcp/80.4.484 6624712

상세보기
17 Stacpoole PW Wright EC Baumgartner TG 1994 Natural history and course of acquired lactic acidosis in adults. DCA-Lactic Acidosis Study Group Am J Med 97 47 54 10.1016/0002-9343(94)90047-7 8030656

상세보기
18 Slottosch I Liakopoulos O Kuhn E 2017 Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock J Crit Care 42 35 41 10.1016/j.jcrc.2017.06.022 28672145

상세보기
19 Fux T Holm M Corbascio M Lund LH van der Linden J 2018 Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: risk factors for mortality J Thorac Cardiovasc Surg 156 1894 902 10.1016/j.jtcvs.2018.05.061 30343699

상세보기

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