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The outcome relevance of pre-ECMO liver impairment in Adults with acute respiratory distress syndrome

We hypothesize that (1) a significant pre-ECMO liver impairment, which is evident in the presence of pre-ECMO acute liver injury and a higher pre-ECMO MELD (model for end-stage liver disease) score, is associated with increased mortality; and (2) the requirement of veno-veno-arterial (V-VA) ECMO sup...

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Hauptverfasser: Sandrio, Stany (VerfasserIn) , Thiel, Manfred (VerfasserIn) , Krebs, Jörg (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 24 July 2023
In: Journal of Clinical Medicine
Year: 2023, Jahrgang: 12, Heft: 14, Pages: 1-18
ISSN:2077-0383
DOI:10.3390/jcm12144860
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.3390/jcm12144860
Verlag, kostenfrei, Volltext: https://www.mdpi.com/2077-0383/12/14/4860
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Verfasserangaben:Stany Sandrio, Manfred Thiel and Joerg Krebs

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520 |a We hypothesize that (1) a significant pre-ECMO liver impairment, which is evident in the presence of pre-ECMO acute liver injury and a higher pre-ECMO MELD (model for end-stage liver disease) score, is associated with increased mortality; and (2) the requirement of veno-veno-arterial (V-VA) ECMO support is linked to a higher prevalence of pre-ECMO acute liver injury, a higher pre-ECMO MELD score, and increased mortality. We analyze 187 ECMO runs (42 V-VA and 145 veno-venous (V-V) ECMO) between January 2017 and December 2020. The SAPS II score is calculated at ICU admission; hepatic function and MELD score are assessed at ECMO initiation (pre-ECMO) and during the first five days on ECMO. SOFA, PRESERVE and RESP scores are calculated at ECMO initiation. Pre-ECMO cardiac failure, acute liver injury, ECMO type, SAPS II and MELD, SOFA, PRESERVE, and RESP scores are associated with mortality. However, only the pre-ECMO MELD score independently predicts mortality (p = 0.04). In patients with a pre-ECMO MELD score > 16, V-VA ECMO is associated with a higher mortality risk (p = 0.0003). The requirement of V-VA ECMO is associated with the development of acute liver injury during ECMO support, a higher pre-ECMO MELD score, and increased mortality. 
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