Ching-Chung Hsiao1, Chih-Hsiang Chang2, Pei-Chun Fan2, Heng-Tsan Ho3, Chang-Chyi Jenq2, Kuo-Chin Kao4, Li-Chung Chiu5, Shen-Yang Lee2, Hsiang-Hao Hsu2, Ya-Chung Tian2, Cheng-Chieh Hung2, Ji-Tseng Fang2, Chih-Wei Yang2, Feng-Chun Tsai6, Yung-Chang Chen7. 1. Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan. 2. Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taipei, Taiwan. 3. Chang Gung University College of Medicine, Taipei, Taiwan. 4. Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taipei, Taiwan. 5. Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan. 6. Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taipei, Taiwan. 7. Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taipei, Taiwan. Electronic address: cyc2356@adm.cgmh.org.tw.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. METHODS: This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. RESULTS: The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. CONCLUSIONS: In ARDS patients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. METHODS: This study reviewed the medical records of 81 ARDSpatients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. RESULTS: The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. CONCLUSIONS: In ARDSpatients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.
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