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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	周伯颐. 体外膜肺氧合联合其他人工生命支持装置在危重患者救治中的应用. 北京协和医学院; 中国医学科学院; 清华大学医学部; 北京协和医学院中国医学科学院, 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.	心源性休克诊断和治疗中国专家共识(2018). 2019江苏省中医、中西医结合急症医学专业学术年会论文集. 江苏高淳, 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.	龙村. 体外膜肺氧合循环支持专家共识中国体外循环杂志, 2014, 12(2): 65-67.
12.	罗建宇. 体外膜肺氧合并发症发生情况及影响患者预后的因素分析. 广西医学, 2022, 44(7): 700-705.
13.	程周, 李斌飞, 廖小卒, 等. 体外膜肺氧合治疗难治性心源性休克的效果及其影响因素分析. 中国体外循环杂志, 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.	庄燕, 戴林峰, 张海东, 等. 新型循环支持和替代系统的作用机制及临床应用研究进展. 东南大学学报(医学版), 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. 周伯颐. 体外膜肺氧合联合其他人工生命支持装置在危重患者救治中的应用. 北京协和医学院; 中国医学科学院; 清华大学医学部; 北京协和医学院中国医学科学院, 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. 心源性休克诊断和治疗中国专家共识(2018). 2019江苏省中医、中西医结合急症医学专业学术年会论文集. 江苏高淳, 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. 龙村. 体外膜肺氧合循环支持专家共识中国体外循环杂志, 2014, 12(2): 65-67.
12. 罗建宇. 体外膜肺氧合并发症发生情况及影响患者预后的因素分析. 广西医学, 2022, 44(7): 700-705.
13. 程周, 李斌飞, 廖小卒, 等. 体外膜肺氧合治疗难治性心源性休克的效果及其影响因素分析. 中国体外循环杂志, 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. 庄燕, 戴林峰, 张海东, 等. 新型循环支持和替代系统的作用机制及临床应用研究进展. 东南大学学报(医学版), 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content