The outcome relevance of pre-ECMO liver impairment in Adults with acute respiratory distress syndrome

• Verfasst von: Sandrio, Stany [VerfasserIn]
• Verfasst von: Thiel, Manfred [VerfasserIn]
• Verfasst von: Krebs, Jörg [VerfasserIn]
• Titel: The outcome relevance of pre-ECMO liver impairment in Adults with acute respiratory distress syndrome
• Verf.angabe: Stany Sandrio, Manfred Thiel and Joerg Krebs
• E-Jahr: 2023
• Jahr: 24 July 2023
• Umfang: 18 S.
• Illustrationen: Illustrationen
• Fussnoten: Gesehen am 26.08.2024
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2023
• Band/Heft Quelle: 12(2023), 14, Artikel-ID 4860, Seite 1-18
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm12144860
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: ARDS
• Sach-SW: ECMO
• Sach-SW: liver injury
• Sach-SW: MELD score
• K10plus-PPN: 1899524088

Abstract

We hypothesize that (1) a significant pre-ECMO liver impairment, which is evident in the presence of pre-ECMO acute liver injury and a higher pre-ECMO MELD (model for end-stage liver disease) score, is associated with increased mortality; and (2) the requirement of veno-veno-arterial (V-VA) ECMO support is linked to a higher prevalence of pre-ECMO acute liver injury, a higher pre-ECMO MELD score, and increased mortality. We analyze 187 ECMO runs (42 V-VA and 145 veno-venous (V-V) ECMO) between January 2017 and December 2020. The SAPS II score is calculated at ICU admission; hepatic function and MELD score are assessed at ECMO initiation (pre-ECMO) and during the first five days on ECMO. SOFA, PRESERVE and RESP scores are calculated at ECMO initiation. Pre-ECMO cardiac failure, acute liver injury, ECMO type, SAPS II and MELD, SOFA, PRESERVE, and RESP scores are associated with mortality. However, only the pre-ECMO MELD score independently predicts mortality (p = 0.04). In patients with a pre-ECMO MELD score > 16, V-VA ECMO is associated with a higher mortality risk (p = 0.0003). The requirement of V-VA ECMO is associated with the development of acute liver injury during ECMO support, a higher pre-ECMO MELD score, and increased mortality.