Combined assessment of vasoactive-inotropic score and lactate to predict mortality in postcardiotomy patients supported with venoarterial extracorporeal membrane oxygenation
10.3760/cma.j.cn112434-20230311-00056
- VernacularTitle:联合血管活性药物－正性肌力药物评分及乳酸预测体外膜肺氧合辅助心脏术后心源性休克患者的预后
- Author:
Xiaqiu TIAN
1
;
Liangshan WANG
;
Chenglong LI
;
Juanjuan SHAO
;
Ming JIA
;
Hong WANG
;
Xiaotong HOU
Author Information
1. 首都医科大学附属北京安贞医院心脏外科危重症中心，北京 100029
- Keywords:
Vasoactive-inotropic score;
Lactate;
Venoarterial extracorporeal membrane oxygenation;
Postcardiotomy cardiogenic shock;
Prognosis
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(9):568-572
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To determine the predictive role of combined assessment of vasoactive-inotropic score(VIS) and lactate for the prognosis of patients with postcardiotomy cardiogenic shock(PCS) requiring venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods:222 adults with PCS requiring VA-ECMO were retrospectively analyzed and divided into four groups according to the cut-off values of VIS and lactate(Lac) at 24 h after ECMO initiation: group 1(59 cases): VIS≤14.5, Lac≤2.45 mmol/L; group 2(17 cases): VIS>14.5, Lac≤2.45 mmol/L; group 3(90 cases): VIS≤14.5, Lac>2.45 mmol/L; group 4(56 cases): VIS>14.5, Lac>2.45 mmol/L. The incidence of in-hospital mortality and other clinical outcomes were analyzed. The associations of VIS and lactate and in-hospital mortality were analyzed using Cox proportional hazards analysis.Results:The in-hospital mortality was 18.6%, 58.8%, 63.3% and 71.4% in the four groups( P<0.001), while the rate of successful weaning off ECMO was 88.1%, 88.2%, 58.9% and 33.9% respectively( P<0.001). The group 1 significantly differed from other three groups with regards to in-hospital mortality and ECMO weaning rate( P<0.05). The groups 1 also showed significantly improved cumulative 60-day survival compared with other three groups( log- rank test, P<0.05). Cox proportional hazards analysis showed age( HR=1.03, 95% CI: 1.01-1.05, P=0.001), female( HR=1.87, 95% CI: 1.27-2.76, P=0.002), VIS at 24 h after ECMO initiation( HR=1.02, 95% CI: 1.00-1.05, P=0.020), and lactate at 24h after ECMO initiation( HR=1.12, 95% CI: 1.08-1.16, P<0.001) were independently predictive of in-hospital mortality. Conclusion:Patients with VIS≤14.5 and Lac≤2.45 within 24 h after ECMO initiation had better in-hospital and 60-day outcomes, suggesting that combined assessment of VIS and lactate may be instructive for determining the prognosis of PCS patients requiring VA-ECMO support.
