Early serum inflammatory cytokine levels and their predictive value for short-term mortality risk in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation therapy
-
摘要: 目的 探讨心源性休克患者接受体外膜肺氧合(extracorporeal membrane oxygenation，ECMO)治疗后早期血清炎症因子水平及其对患者短期死亡风险的预测价值。 方法 回顾性分析2020年3月—2024年2月收治的经ECMO治疗的心源性休克患者20例为研究对象，依据患者28 d内是否死亡分为存活组(7例)和死亡组(13例)。分析比较存活组和死亡组患者第1天及第3天急性生理与慢性健康评分(acute physiology and chronic health evaluation，APACHE Ⅱ)、序贯器官衰竭评分(sequential organ failure assessment，SOFA)和血清炎症因子变化及其对患者短期死亡风险的预测价值。 结果 单因素分析显示，ECMO治疗的心源性休克患者28 d内存活组与死亡组在第1天APACHE Ⅱ评分和SOFA评分、第3天APACHE Ⅱ评分、SOFA评分、神经元特异性烯醇化酶(neuron-specific enolase，NSE)、乳酸(lactate，LAC)、D-二聚体、肌钙蛋白、心脏射血分数(EF值)、肌酐等方面比较，差异有统计学意义(P < 0.05)。分别以第1天APACHE Ⅱ评分和SOFA评分、第3天APACHEⅡ评分、SOFA评分、NSE、LAC、D-二聚体、肌钙蛋白、EF值、肌酐指标为参考，预测ECMO治疗心源性休克患者28 d内死亡的受试者工作特征曲线下面积为0.813~0.923，且差异有统计学意义(P < 0.05)。 结论 心源性休克患者接受ECMO治疗后28 d死亡与存活患者血清炎症因子水平及APACHE Ⅱ评分、SOFA评分存在显著差异，且可作为预测患者短期死亡风险的指标。Abstract: Objective To explore the early serum inflammatory cytokine levels and their predictive value for short-term mortality risk in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation(ECMO) therapy. Methods A retrospective analysis was conducted on 20 patients with cardiogenic shock treated with ECMO from March 2020 to February 2024. Patients were divided into a survival group(7 cases) and a death group(13 cases) based on whether they died within 28 days. The acute physiology and chronic health evaluation(APACHE Ⅱ) score, sequential organ failure assessment(SOFA) score, and changes in serum inflammatory factors on the first and the third days between the survival and death groups were compared, and their predictive value for short-term mortality risk in patients were analyzed. Results Univariate analysis showed that there were significant differences in APACHE Ⅱ score and SOFA score on the first day, APACHE Ⅱ score, SOFA score, neuron-specific enolase(NSE), lactate(LAC), D-dimer, troponin, ejection fraction(EF) value, creatinine, and other parameters on the third days between the survival group and the death group of patients with cardiogenic shock treated with ECMO at 28 days(P < 0.05). Using the APACHE Ⅱ score and SOFA score on the first day, as well as the APACHE Ⅱ score, SOFA score, NSE, LAC, D-dimer, troponin, EF value, and creatinine index on the third day as references, the area under the receiver operating characteristic curve for predicting death within 28 days of ECMO treatment in patients with cardiogenic shock ranged from 0.813 to 0.923, and the difference was statistically significant(P < 0.05). Conclusion There are significant differences in serum inflammatory cytokine levels, APACHE Ⅱ score, and SOFA score between patients who died and survived within 28 days after receiving ECMO therapy for cardiogenic shock, and they can be used as indicators to predict the short-term mortality risk of patients.
-
-
表 1 存活组和死亡组患者APACHE Ⅱ评分、SOFA评分和血清炎症因子比较
X±S 因素 存活组(7例) 死亡组(13例) t/χ2 P 年龄/岁 51.42±13.70 59.15±14.83 -1.17 0.260 男∶女/例 6∶1 10∶3 0.22 0.649 第1天APACHE Ⅱ评分/分 26.00±5.89 36.46±5.35 -3.91 0.002 第3天APACHE Ⅱ评分/分 20.71±5.68 32.69±8.15 -3.84 0.001 第1天SOFA评分/分 9.42±3.26 13.69±3.64 -2.68 0.018 第3天SOFA评分/分 7.85±4.22 13.23±3.96 -2.77 0.017 机械通气时间/h 151.29±104.41 112.54±112.97 0.77 0.455 ECMO首次维持时间/h 83.57±59.30 79.23±32.26 0.18 0.862 ECMO血流量/(L/min) 2.99±0.59 3.05±0.68 -2.22 0.827 第1天NSE/(ng/mL) 41.82±21.08 66.88±36.22 -1.96 0.067 第3天NSE/(ng/mL) 56.16±67.12 158.22±99.37 -2.73 0.015 第1天LAC/(mmol/L) 8.37±6.77 13.97±5.12 -1.92 0.085 第3天LAC/(mmol/L) 2.83±2.12 10.86±8.66 -3.17 0.007 第1天D-二聚体/(mg/L) 24.87±44.38 39.29±32.32 -0.76 0.467 第3天D-二聚体/(mg/L) 7.39±9.11 25.78±15.90 -3.29 0.004 第1天白细胞计数/(×109/L) 17.20±6.11 13.99±5.84 1.15 0.263 第3天白细胞计数/(×109/L) 11.10±3.61 13.65±2.88 -1.73 0.103 第1天中性粒细胞百分比/% 88.03±4.53 84.45±8.72 1.21 0.222 第3天中性粒细胞百分比/% 84.58±7.06 88.40±6.05 -1.27 0.254 第1天CRP/(mg/L) 7.10±8.56 16.52±17.02 -1.65 0.117 第3天CRP/(mg/L) 118.30±66.42 115.11±69.50 0.10 0.921 第1天PCT/(ng/mL) 3.78±4.77 275.98±946.56 -1.04 0.320 第3天PCT/(ng/mL) 11.87±21.43 37.27±42.28 -1.78 0.092 第1天肌钙蛋白/(μg/L) 32.31±42.89 214.74±415.96 -1.56 0.143 第3天肌钙蛋白/(μg/L) 15.99±20.59 143.78±165.92 -2.74 0.017 第1天EF值 0.43±0.14 0.31±0.17 1.58 0.136 第3天EF值 0.54±0.08 0.33±0.20 3.53 0.003 第1天肌酐/(μmol/L) 111.71±44.65 152.62±52.64 -1.83 0.088 第3天肌酐/(μmol/L) 94.28±42.21 201.07±121.66 -2.86 0.011 第1天血小板计数/(×109/L) 179.57±72.93 126.61±59.55 1.65 0.129 第3天血小板计数/(×109/L) 110.85±43.12 61.69±26.78 2.74 0.024 第1天纤维蛋白原/(g/L) 2.33±0.86 2.27±3.21 0.05 0.960 第3天纤维蛋白原/(g/L) 5.50±1.99 4.20±5.11 0.64 0.530 
下载: 导出CSV
表 2 相关指标预测ECMO治疗心源性休克患者28 d内死亡价值
因素 AUC SE P 95%CI 第1天APACHE Ⅱ评分 0.923 0.059 0.002 0.807~1.000 第3天APACHE Ⅱ评分 0.890 0.073 0.005 0.747~1.000 第1天SOFA评分 0.835 0.105 0.016 0.629~1.000 第3天SOFA评分 0.824 0.115 0.019 0.598~1.000 第3天NSE 0.813 0.102 0.024 0.613~1.000 第3天LAC 0.890 0.077 0.005 0.740~1.000 第3天D-二聚体 0.835 0.096 0.016 0.648~1.000 第3天肌钙蛋白 0.835 0.093 0.016 0.652~1.000 第3天EF值 0.891 0.094 0.022 0.634~1.000 第3天肌酐 0.879 0.080 0.006 0.723~1.000
下载: 导出CSV
-
[1] Abuelazm M, Nawlo A, Ibrahim AA, et al. Early left ventricular unloading during extracorporeal membrane oxygenation in cardiogenic shock: A systematic review and meta-analysis[J]. Artif Organs, 2024 Nov 4. doi:
10.1111/aor.14898 .Onlineaheadofprint.[2] Berg DD, Bohula EA, Morrow DA. Epidemiology and causes of cardiogenic shock[J]. Curr Opin Crit Care, 2021, 27(4): 401-408. doi: 10.1097/MCC.0000000000000845
[3] Laghlam D, Benghanem S, Ortuno S, et al. Management of cardiogenic shock: a narrative review[J]. Ann Intensive Care, 2024, 14(1): 45. doi: 10.1186/s13613-024-01260-y
[4] Milne B, Dalzell JR, Kunst G. Management of cardiogenic shock after acute coronary syndromes[J]. BJA Educ, 2023, 23(5): 172-181. doi: 10.1016/j.bjae.2023.01.006
[5] Napp LC, Kühn C, Bauersachs J. ECMO in cardiac arrest and cardiogenic shock[J]. Herz, 2017, 42(1): 27-44. doi: 10.1007/s00059-016-4523-4
[6] Chakaramakkil MJ, Sivathasan C. ECMO in cardiogenic shock and bridge to heart transplant[J]. Indian J Thorac Cardiovasc Surg, 2021, 37(Suppl 2): 319-326.
[7] Khan MF, Nazir M, Khan MK, et al. Extracorporeal Membrane Oxygenation as Circulatory Support in Adult Patients with Septic Shock: A Systematic Review[J]. J Crit Care Med(Targu Mures), 2024, 10(2): 119-129. doi: 10.2478/jccm-2024-0017
[8] Ostadal P, Rokyta R, Karasek J, et al. Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial[J]. Circulation, 2023, 147(6): 454-464. doi: 10.1161/CIRCULATIONAHA.122.062949
[9] Banning AS, Sabaté M, Orban M, et al. Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial[J]. EuroIntervention, 2023, 19(6): 482-492. doi: 10.4244/EIJ-D-23-00204
[10] Broman LM, Dubrovskaja O, Balik M. Extracorporeal Membrane Oxygenation for Septic Shock in Adults and Children: A Narrative Review[J]. J Clin Med, 2023, 12(20): 6661. doi: 10.3390/jcm12206661
[11] Koziol KJ, Isath A, Rao S, et al. Extracorporeal Membrane Oxygenation(VA-ECMO)in Management of Cardiogenic Shock[J]. J Clin Med, 2023, 12(17): 5576. doi: 10.3390/jcm12175576
[12] Samsky MD, Morrow DA, Proudfoot AG, et al. Cardiogenic Shock After Acute Myocardial Infarction: A Review[J]. JAMA, 2021, 326(18): 1840-1850. doi: 10.1001/jama.2021.18323
[13] Morrow DA, van Diepen S. The extracorporeal membrane oxygenation in the therapy of cardiogenic shock(ECMO-CS)trial in perspective[J]. Eur Heart J Acute Cardiovasc Care, 2022, 11(12): 933-935. doi: 10.1093/ehjacc/zuac145
[14] Zhou L, Mo X, Huang G, et al. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock induced by adrenal lesions: a case report and review of the literature[J]. World J Emerg Med, 2023, 14(4): 325-328. doi: 10.5847/wjem.j.1920-8642.2023.064
[15] Heinsar S, Sato K, Obonyo N, et al. Improved Microcirculation with Pulsatile Venoarterial Extracorporeal Membrane Oxygenation: An Ovine Model of Cardiogenic Shock[J]. Am J Respir Crit Care Med, 2024, 209(11): 1396-1399. doi: 10.1164/rccm.202402-0419LE
[16] Rob D, Belohlavek J. Beyond one-size-fits-all in cardiogenic shock: impella, extracorporeal membrane oxygenation or tailored use of mechanical circulatory support[J]. Curr Opin Crit Care, 2024, 30(4): 371-378. doi: 10.1097/MCC.0000000000001165
[17] Ya'Qoub L, Alqarqaz M, Cowger J, et al. Cardiogenic shock in a young woman with SCAD: The importance of early access to VA-ECMO in the community[J]. Cardiovasc Revasc Med, 2024, 59: 81-83. doi: 10.1016/j.carrev.2023.06.023
[18] Vora N, Chaudhary R, Upadhyay HV, et al. Mechanical Assist Device-Assisted Percutaneous Coronary Intervention: The Use of Impella Versus Extracorporeal Membrane Oxygenation as an Emerging Frontier in Revascularization in Cardiogenic Shock[J]. Cureus, 2023, 15(1): e33372.
[19] Rahhal A, Omar AS, Aljundi A, et al. Successful Use of Intravenous B-blocker Therapy in Cardiogenic Shock Supported With Venoarterial Extracorporeal Membrane Oxygenation: A Case Series[J]. Curr Probl Cardiol, 2022, 47(11): 101071. doi: 10.1016/j.cpcardiol.2021.101071
[20] Kologrivova I, Kercheva M, Panteleev O, et al. The Role of Inflammation in the Pathogenesis of Cardiogenic Shock Secondary to Acute Myocardial Infarction: A Narrative Review[J]. Biomedicines, 2024, 12(9): 2073. doi: 10.3390/biomedicines12092073
-
计量
- 文章访问数: 257
- 施引文献: 0