Value of different scoring systems in predicting mortality of patients with cardiogenic shock supported by extracorporeal membrane oxygenation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LU Yuanbo ,  WANG Xiaoyuan , LV Guangyu

Intensive Care Unit, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, P. R. China;

Corresponding?author：

WANG Xiaoyuan, Email: wangxiaoyuan1025@163.com

Keywords：

Extracorporeal membrane oxygenation; prognostic score; cardiogenic shock; fatality rate

DOI：

10.7507/1671-6205.202405148

Video：

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Objective To investigate the predictive value of extracorporeal membrane oxygenation (ECMO) pre-computer multiple scoring systems in the mortality of patients with cardiogenic shock. Methods A retrospective analysis was performed on 100 patients with cardiogenic shock due to various reasons who were treated with veno-arterial ECMO (VA-ECMO) from July 2020 to July 2022. The patients were followed up for 30 days and divided into a survival group (35 cases) and a death group (65 cases) according to whether they survived 30 days after withdrawal. General clinical data, blood biochemistry data within 24 hours before ECMO, ventilator parameters, past medical history and other data were collected, and sequential organ failure score (SOFA) before VA-ECMO, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), survival after veno-arterial ECMO (SAVE) score and modified SAVE score were calculated. Blood biochemical indicators and clinical scores related to patient prognosis were screened using two-independent sample t test or Man-Whitney U test. The predictive efficacy of each score on short-term prognosis (30-day post-discharge mortality) was evaluated by receiver operating characteristic curve and area under curve (AUC). Results There were significant differences in APACHEⅡ score, SAVE score and modified SAVE score between two groups (P<0.05). The AUC and its 95%CI of APACHEⅡ score was 0.696 (95%CI 0.592 - 0.801), of SAVE score was 0.617 (95%CI 0.498 - 0.736), and of post SAVE score was 0.664 (95%CI 0.545 - 0.782), respectively. All AUCs were relatively low (<0.75). Conclusion SOFA, APACHEⅡ, SAVE score and modified SAVE score have limited clinical value in the prognosis assessment of ECMO patients, and do not show obvious advantages.

Citation： LU Yuanbo, WANG Xiaoyuan, LV Guangyu. Value of different scoring systems in predicting mortality of patients with cardiogenic shock supported by extracorporeal membrane oxygenation. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(3): 192-196. doi: 10.7507/1671-6205.202405148 Copy

1.	周伯頤. 體外膜肺氧合聯合其他人工生命支持裝置在危重患者救治中的應用. 北京協和醫學院; 中國醫學科學院; 清華大學醫學部; 北京協和醫學院中國醫學科學院, 2017.
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3.	Rao P, Khalpey Z, Smith R, et al. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail, 2018, 11(9): e004905.
4.	Lin CY, Tsai FC, Tian YC, et al. Evaluation of outcome scoring systems for patients on extracorporeal membrane oxygenation. Ann Thorac Surg, 2007, 84(4): 1256-1262.
5.	Chiu LC, Tsai FC, Hu HC, et al. Survival predictors in acute respiratory distress syndrome with extracorporeal membrane oxygenation Ann Thorac Surg, 2015, 99(1): 243-250.
6.	心源性休克診斷和治療中國專家共識(2018). 2019江蘇省中醫、中西醫結合急癥醫學專業學術年會論文集. 江蘇高淳, 2019: 27-39.
7.	Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med, 1996, 22(7): 707-710.
8.	Knaus WA, Draper EA, Wagner DP, et al. APACHE 1I: a severity of disease classification system. Crit Care Med, 1985, 13(10): 818-829.
9.	Chen WC, Huang KY, Yao CW, et al. The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department. Crit Care, 2016, 20(1): 336. DOI: 0.1186/s13054-016-1520-1.
10.	Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J, 2015, 36(33): 2246-2256.
11.	龍村. 體外膜肺氧合循環支持專家共識中國體外循環雜志, 2014, 12(2): 65-67.
12.	羅建宇. 體外膜肺氧合并發癥發生情況及影響患者預后的因素分析. 廣西醫學, 2022, 44(7): 700-705.
13.	程周, 李斌飛, 廖小卒, 等. 體外膜肺氧合治療難治性心源性休克的效果及其影響因素分析. 中國體外循環雜志, 2017, 15(3): 159-162.
14.	Liu CB, Suo SZ, Luo LY, et al. SOFA Score in relation to sepsis: clinical implications in diagnosis, treatment, and prognostic assessment. Comput Math Methods Med, 2022, 2022: 7870434.
15.	Karnes JH, Arora A, Feng J, et al. Racial, ethnic, and gender differences in obesity and body fat distribution: an all of us research program demonstration project. PLoS One, 2021, 16(8): e0255583.
16.	Danaei G, Finucane MM, Lin JK et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. Lancet, 2011, 377(9765): 568-577.
17.	Fisser C, Rincon-Gutierrez LA, Enger TB, et al. Validation of prognostic scores in extracorporeal life support: a multi-centric retrospective study. Membranes (Basel), 2021, 11(2): 84.
18.	莊燕, 戴林峰, 張海東, 等. 新型循環支持和替代系統的作用機制及臨床應用研究進展. 東南大學學報(醫學版), 2019, 38(6): 1073-1077. DOI: 0.3969/j.issn.1671-6264.2019.06.029.
19.	Hemmila MR, Rowe SA, Boules TN, et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg, 2004, 240(4): 595-605.
20.	Brogan TV, Thiagarajan RR, Rycus PT, et al. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med, 2009, 35(12): 2105-2014.
21.	Chen YS, Chao A, Yu HY, et al. Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol, 2003, 41(2): 197-203. DOI: 0.1016/S0735-1097(02)02716-X.
22.	Park SJ, Kim SP, Kim JB, et al. Blood lactate level during extracorporeal life support as a surrogate marker for survival. J Thorac Cardiovasc Surg, 2014, 148(2): 714-720.
23.	Li CL, Wang H, Jia M, et al. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg, 2015, 149(5): 1445-1450.

1. 周伯頤. 體外膜肺氧合聯合其他人工生命支持裝置在危重患者救治中的應用. 北京協和醫學院; 中國醫學科學院; 清華大學醫學部; 北京協和醫學院中國醫學科學院, 2017.
2. Napp LC, Kühn C, Bauersachs J. ECMO in cardiac arrest and cardiogenic shock. Herz, 2017, 42(1): 27-44. DOI: 0.1007/s00059-016-4523-4.
3. Rao P, Khalpey Z, Smith R, et al. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail, 2018, 11(9): e004905.
4. Lin CY, Tsai FC, Tian YC, et al. Evaluation of outcome scoring systems for patients on extracorporeal membrane oxygenation. Ann Thorac Surg, 2007, 84(4): 1256-1262.
5. Chiu LC, Tsai FC, Hu HC, et al. Survival predictors in acute respiratory distress syndrome with extracorporeal membrane oxygenation Ann Thorac Surg, 2015, 99(1): 243-250.
6. 心源性休克診斷和治療中國專家共識(2018). 2019江蘇省中醫、中西醫結合急癥醫學專業學術年會論文集. 江蘇高淳, 2019: 27-39.
7. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med, 1996, 22(7): 707-710.
8. Knaus WA, Draper EA, Wagner DP, et al. APACHE 1I: a severity of disease classification system. Crit Care Med, 1985, 13(10): 818-829.
9. Chen WC, Huang KY, Yao CW, et al. The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department. Crit Care, 2016, 20(1): 336. DOI: 0.1186/s13054-016-1520-1.
10. Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J, 2015, 36(33): 2246-2256.
11. 龍村. 體外膜肺氧合循環支持專家共識中國體外循環雜志, 2014, 12(2): 65-67.
12. 羅建宇. 體外膜肺氧合并發癥發生情況及影響患者預后的因素分析. 廣西醫學, 2022, 44(7): 700-705.
13. 程周, 李斌飛, 廖小卒, 等. 體外膜肺氧合治療難治性心源性休克的效果及其影響因素分析. 中國體外循環雜志, 2017, 15(3): 159-162.
14. Liu CB, Suo SZ, Luo LY, et al. SOFA Score in relation to sepsis: clinical implications in diagnosis, treatment, and prognostic assessment. Comput Math Methods Med, 2022, 2022: 7870434.
15. Karnes JH, Arora A, Feng J, et al. Racial, ethnic, and gender differences in obesity and body fat distribution: an all of us research program demonstration project. PLoS One, 2021, 16(8): e0255583.
16. Danaei G, Finucane MM, Lin JK et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. Lancet, 2011, 377(9765): 568-577.
17. Fisser C, Rincon-Gutierrez LA, Enger TB, et al. Validation of prognostic scores in extracorporeal life support: a multi-centric retrospective study. Membranes (Basel), 2021, 11(2): 84.
18. 莊燕, 戴林峰, 張海東, 等. 新型循環支持和替代系統的作用機制及臨床應用研究進展. 東南大學學報(醫學版), 2019, 38(6): 1073-1077. DOI: 0.3969/j.issn.1671-6264.2019.06.029.
19. Hemmila MR, Rowe SA, Boules TN, et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg, 2004, 240(4): 595-605.
20. Brogan TV, Thiagarajan RR, Rycus PT, et al. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med, 2009, 35(12): 2105-2014.
21. Chen YS, Chao A, Yu HY, et al. Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol, 2003, 41(2): 197-203. DOI: 0.1016/S0735-1097(02)02716-X.
22. Park SJ, Kim SP, Kim JB, et al. Blood lactate level during extracorporeal life support as a surrogate marker for survival. J Thorac Cardiovasc Surg, 2014, 148(2): 714-720.
23. Li CL, Wang H, Jia M, et al. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg, 2015, 149(5): 1445-1450.

Chinese Journal of Respiratory and Critical Care Medicine

Value of different scoring systems in predicting mortality of patients with cardiogenic shock supported by extracorporeal membrane oxygenation

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