弥散性血管内凝血评分与体外膜氧合患者结局的相关性分析

Relationship between disseminated intravascular coagulation score during venoarterial extracorporeal membrane oxygenation and outcomes

目的:本研究拟回顾性分析心脏术后应用股静脉体外膜氧合(VA-ECMO)辅助的患者资料,评价弥散性血管内凝血(DIC)评分与VA-ECMO患者住院死亡的关系。方法:回顾性分析了北京安贞医院心脏外科危重症中心在2015年1月至2018年12月期间,心脏手术后因心源性休克应用VA-ECMO辅助的222例患者,分为院内存活组(n=105)和院内死亡组(n=117)。用Logistic回归分析评估DIC评分与患者住院死亡的关系。结果:222例患者中145例(65%)成功脱离ECMO,105例(47%)顺利出院。中位ECMO辅助时间、ICU滞留时间、住院时间分别为5(3,6)、8(5,12)、19(12,26)d。ECMO期间,中位DIC评分峰值为5(4,6)。53%的患者DIC评分在ECMO启动后1 d内达到了峰值,82%的患者在3 d内达到峰值。调整年龄,性别,ECMO适应证和血清乳酸后,DIC评分峰值与住院死亡相关(OR=2.20,95%CI:1.64~2.95)。结论:ECMO期间DIC评分与住院死亡相关,可能帮助临床医生更早识别高危的ECMO患者。

Objective:To evaluate the relationship between disseminated intravascular coagulation(DIC)score during venoarterial extracorporeal membrane oxygenation(VA-ECMO)and short-term mortality.Methods:We included 222 post-cardiotomy cardiogenic shock patients supported with VA-ECMO at Beijing Anzhen Hospital between January 2015 and December 2018.DIC score at cannulation,DIC score at day 1-15 from ECMO initiation were collected.Multivariable logistic regression analysis was performed to assess the rela-tionship between peak DIC score during ECMO and in-hospital mortality.Results:Of 222 PCS patients treated with VA-ECMO,145(65%)patients were weaned from VA-ECMO.The median(IQR)time on VA-ECMO support was 5(3,6)days.The median(IQR)length of ICU stay and hospital stay duration were 8(5,12)and 19(12,26)days,respectively.The median(IQR)peak DIC score was 5(4,6).Most patients achieved their peak DIC score within 1 day,and 82%within 3 days after ECMO initiation.After adjusting for age,sex,ECMO indications,and peak serum lactate,peak DIC score during ECMO expressed as a continuous variable was associated with in-hospital mortality(OR=2.20,95%CI:1.64-2.95).Conclusions:DIC score is associated with short-term mortality in patients undergoing VA-ECMO after cardiac surgery,and might help cli-nicians to identify high-risk patients early.