High Serum Bilirubin Levels, NT-pro-BNP, and Lactate Predict Mortality in Long-Term, Severely Ill Respiratory ECMO Patients

Abstract

Mortality in patients treated with extracorporeal membrane oxygenation (ECMO) is high. Therefore, it is crucial to better understand conditions that are associated with mortality in ECMO patients. In this retrospective analysis, we observed 51 patients treated with high-flow ECMO in 2013 and 2014 at our center. We recorded laboratory values and intensive care procedures. The hypothesis of bilirubin being a predictor of mortality during ECMO treatment was initially addressed. Therefore, laboratory values were obtained before initiation and at the time of highest bilirubin throughout the procedure. Receiver operating characteristic (ROC) curves and survival analysis were conducted. Our cohort consisted of patients with advanced age (median: 55 years; range: 22-76) and high mortality (26/51; 51%). Lactate, bilirubin, and NT-pro-BNP were significantly (p < 0.05) associated with mortality in univariable analyses. The cut-off values with highest Youden's index were bilirubin ≥10 mg/dl, lactate ≥2.25 mmol/L, and NT-pro-BNP ≥11,500 pg/ml. A multivariable analysis, revealed an area under the curve (AUC) of 0.85 (95% confidence interval [CI]: 0.74-0.97), sensitivity of 0.79, and specificity of 0.91. Bilirubin, lactate, and NT-pro-BNP were associated with mortality during ECMO treatment. However, laboratory values were only evaluated at the time of peak bilirubin.

Veno-arterial extracorporeal membrane oxygenation: Special reference for use in ‘post-cardiotomy cardiogenic shock’ — A review with an Indian perspective

“…Hyperbilirubinaemia, an independent predictor of poor outcomes, occurs due to a combination of extracorporeal haemolysis and liver dysfunction [ 57 ]. Elevated alkaline phosphatase, lactate and BNP are associated with poor outcomes [ 58 ], while elevated AST and ALT levels do not seem to be predictive. In patients on ECMO, studies have shown that baseline Model for End stage Liver Disease, United Network for Organ Sharing modification (MELD UNOS) [ 59 ] and Model for End Stage Liver Disease score excluding INR (MELD XI) [ 60 ] scores can predict outcomes.…”

Organ Dysfunction and Mortality Relationship in Patients with Extracorporeal Membrane Oxygenation After Pediatric Cardiac Surgery

“…Kaestner ve ark. 'nın [29] çalışmasında ise, bilirubin, laktat ve N-terminal pro-brain natriüretik peptid ECMO sırasındaki mortalite ile ilişkilendirilmiştir. Ancak, bu çalışmada bilirubin değerleri yalnızca en yüksek olduğu dönemde çalışılmıştır.…”

Hypoperfusionssyndrom und kardiogener Schock

“…noch laufende Reanimation sind wichtige Aspekte. Laborchemisch spielen das Laktat, das akute Nierenversagen oder ein Leberversagen also der Ausdruck des sich entwickelnden MODS (Multiorgandysfunktionssyndrom)eine wesentliche Rolle [4,15]. Auch die Aufnahme in ein großes Krankenhaus mit allen Möglichkeiten der Versorgung des kardiogenen Schockes scheint nicht nur zu einem vermehrten Einsatz der Systeme zu führen, sondern auch die Mortalität günstig zu beeinflussen [3,4].…”

“…Dadurch können bei liegenden ECLS-Schleusen Entscheidungshilfen für die antegrade Punktion gegeben werden [38,39]. Nach metaanalytischen Daten unter Einschluss von 1866 Patienten liegt die Rate an Beinischämien bei 16,9 % [ CI 12,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]6], an Fasziotomien oder Kompartment-Syndromen bei 10,3 % [CI 7,3-14,5] und die Rate an Amputationen bei 4,7 % [CI 2,3-9,3] [40].…”