Predictive value of APACHEⅡ score combined with systematic inflammation markers on outcome in patients with extracorporeal membrane oxygenation
10.3760/cma.j.issn.1671-0282.2022.11.011
- VernacularTitle:急性生理和慢性健康评分Ⅱ联合全血细胞亚型比值与静脉-动脉体外膜肺氧合患者结局相关性分析
- Author:
Di AN
1
;
Xufeng CHEN
;
Wei LI
;
Yi ZHU
;
Zhongman ZHANG
;
Yue ZOU
;
Tao DING
;
Weixiao XU
Author Information
1. 南京医科大学第一附属医院急诊医学中心,南京 210029
- Keywords:
Acute physiology and chronic health scoreⅡ;
Platelet-to-lymphocyte ratio;
Lymphocyte-to-monocyte ratio;
Inflammation;
Extracorporeal membrane oxygenation
- From:
Chinese Journal of Emergency Medicine
2022;31(11):1498-1503
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical significance of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) combined with different systematic inflammation markers (SIMs) including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-in adult patients with venous-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A total of 89 adult patients with VA-ECMO ( ≥ 3 d) in the Emergency Department of Jiangsu Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed. Patients were divided into two groups: survivors ( n=39) and non-survivors ( n=50). The baseline APACHE Ⅱscore and PLR, NLR, LMR before ECMO implantation and at 1, 2, 3 day after ECMO were recorded. Binary logistic regression was used to analyze the risk factors of 28-day mortality in patients with VA-ECMO. The utility of APACHEⅡ score and SIMs alone or combination for predicting clinical prognosis was evaluated using receiver operating characteristic (ROC) curve analysis. The patients were divided into the high risk group and the low risk group according to the best cut-off value, and the difference of ECMO-related complications between the two groups was compared. Results:When combined APACHEⅡ score with SIMs, APACHEⅡ + PLR 48 h + LMR 24 h + LMR 72 h demonstrated the greatest predictive ability with an AUC of 0.833. Compared with the high-risk group, the low-risk group has a lower incidence of acute renal injury, infection, bleeding complications, the use of continuous renal replacement therapy, mechanical ventilation, and a higher hospital survival rate.Conclusions:The combination of APACHEⅡ score and SIMs-PLR, LMR- is better than a single one for death prediction, and it is expected to be a new predictive model for early identification of the risk of death or poor prognosis in patients with VA-ECMO.
