Moon Seong Baek1, Chi Ryang Chung2, Hwa Jung Kim3, Woo Hyun Cho4, Young-Jae Cho5, Sunghoon Park6, Seung Yong Park7, Byung Ju Kang8, Jung-Hyun Kim9, So Hee Park10, Jin Young Oh11, Yun Su Sim12, Sang-Bum Hong1. 1. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea. 2. Department of Critical Care Medicine, Samsung Medical Center, Seoul, Republic of Korea. 3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea. 4. Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea. 5. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. 6. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea. 7. Department of Internal Medicine, Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea. 8. Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea. 9. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bundang CHA Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. 10. Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea. 11. Divisions of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. 12. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Abstract
BACKGROUND: The proportion of elderly patients in the intensive care unit population is increasing. Although the Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score is widely used for survival prediction of extracorporeal membrane oxygenation (ECMO) patients, it is questionable whether the RESP score is applicable to older patients. The aim of this study was to investigate the applicability of the RESP score in Korean cohort. METHODS: Data were retrospectively analyzed from 209 acute respiratory failure (ARF) patients treated with ECMO from 2014 to 2015 at 11 hospitals. A comparison of outcome prediction models was conducted and multivariate logistic regression analysis was performed to identify independent risk factors for hospital mortality. RESULTS: In all patients, the median age was 58 (IQR, 45-65) years. Overall survival at hospital discharge was 45.9%, and veno-venous ECMO was used in 82.3% of patients. Patients older than 65 years treated with ECMO support were 51 with 31.4% of hospital survival. The PRedicting dEath for SEvere ARDS on VV-ECMO (PRESERVE) and RESP scores significantly predicted mortality in patients, with areas under the curve (AUCs) of 0.63 [95% confidence interval (CI), 0.54-0.72] and 0.66 (95% CI, 0.58-0.73), respectively. In multivariate logistic regression analysis, age is independent risk factor for hospital mortality [odds ratio 1.044 (95% CI, 1.020-1.068), P<0.001] with AUC of 0.67 (95% CI, 0.59-0.74). The RESP score was modified using reclassified age and the modified RESP score obtained AUC of 0.71 (95% CI, 0.63-0.78). CONCLUSIONS: The RESP score is significant model for predicting outcomes in a Korean ECMO population. Elderly patients had higher mortality, and age alone showed similar discrimination ability for prediction of mortality compared to the RESP score.
BACKGROUND: The proportion of elderly patients in the intensive care unit population is increasing. Although the Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score is widely used for survival prediction of extracorporeal membrane oxygenation (ECMO) patients, it is questionable whether the RESP score is applicable to older patients. The aim of this study was to investigate the applicability of the RESP score in Korean cohort. METHODS: Data were retrospectively analyzed from 209 acute respiratory failure (ARF) patients treated with ECMO from 2014 to 2015 at 11 hospitals. A comparison of outcome prediction models was conducted and multivariate logistic regression analysis was performed to identify independent risk factors for hospital mortality. RESULTS: In all patients, the median age was 58 (IQR, 45-65) years. Overall survival at hospital discharge was 45.9%, and veno-venous ECMO was used in 82.3% of patients. Patients older than 65 years treated with ECMO support were 51 with 31.4% of hospital survival. The PRedicting dEath for SEvere ARDS on VV-ECMO (PRESERVE) and RESP scores significantly predicted mortality in patients, with areas under the curve (AUCs) of 0.63 [95% confidence interval (CI), 0.54-0.72] and 0.66 (95% CI, 0.58-0.73), respectively. In multivariate logistic regression analysis, age is independent risk factor for hospital mortality [odds ratio 1.044 (95% CI, 1.020-1.068), P<0.001] with AUC of 0.67 (95% CI, 0.59-0.74). The RESP score was modified using reclassified age and the modified RESP score obtained AUC of 0.71 (95% CI, 0.63-0.78). CONCLUSIONS: The RESP score is significant model for predicting outcomes in a Korean ECMO population. Elderly patients had higher mortality, and age alone showed similar discrimination ability for prediction of mortality compared to the RESP score.
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