Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study
Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods:...
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MDPI AG
2021-01-01
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| Series: | Membranes |
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| Online Access: | https://www.mdpi.com/2077-0375/11/2/84 |
| _version_ | 1827598354234736640 |
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| author | Christoph Fisser Luis Alberto Rincon-Gutierrez Tone Bull Enger Fabio Silvio Taccone Lars Mikael Broman Mirko Belliato Leda Nobile Federico Pappalardo Maximilian V. Malfertheiner |
| author_facet | Christoph Fisser Luis Alberto Rincon-Gutierrez Tone Bull Enger Fabio Silvio Taccone Lars Mikael Broman Mirko Belliato Leda Nobile Federico Pappalardo Maximilian V. Malfertheiner |
| author_sort | Christoph Fisser |
| collection | DOAJ |
| description | Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five ECMO centers included 300 patients on VA and 329 on VV ECMO support (March 2008 to November 2016). Different prognostic scores were compared between survivors and non-survivors: APACHE II, SOFA, SAPS II in all patients; SAVE, modified SAVE and MELD-XI in VA ECMO; RESP, PRESET, ROCH and PRESERVE in VV ECMO. Model performance was compared using receiver-operating-curve analysis and assessment of model calibration. Survival was assessed at intensive care unit discharge. Results: The main indication for VA ECMO was cardiogenic shock; overall survival was 51%. ICU survivors had higher Glasgow Coma Scale scores and pH, required cardiopulmonary resuscitation (CPR) less frequently, had lower lactate levels and shorter ventilation time pre-ECMO at baseline. The best discrimination between survivors and non-survivors was observed with the SAPS II score (area under the curve [AUC] of 0.73 (95% CI 0.67–0.78)). The main indication for VV ECMO was pneumonia; overall survival was 60%. Lower PaCO<sub>2</sub>, higher pH, lower lactate and lesser need for CPR were observed among survivors. The best discrimination between survivors and non-survivors was observed with the PRESET score (AUC 0.66 (95% CI 0.60–0.72)). Conclusion: The prognostic performance of most scores was moderate in ECMO patients. The use of such scores to decide about ECMO implementation in potential candidates should be discouraged. |
| first_indexed | 2024-03-09T03:50:26Z |
| format | Article |
| id | doaj.art-5fa6623b91ee41a5a54ae747c01d36cb |
| institution | Directory Open Access Journal |
| issn | 2077-0375 |
| language | English |
| last_indexed | 2024-03-09T03:50:26Z |
| publishDate | 2021-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Membranes |
| spelling | doaj.art-5fa6623b91ee41a5a54ae747c01d36cb2023-12-03T14:28:20ZengMDPI AGMembranes2077-03752021-01-011128410.3390/membranes11020084Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective StudyChristoph Fisser0Luis Alberto Rincon-Gutierrez1Tone Bull Enger2Fabio Silvio Taccone3Lars Mikael Broman4Mirko Belliato5Leda Nobile6Federico Pappalardo7Maximilian V. Malfertheiner8Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, B-1070 Brussels, BelgiumClinic of Cardiology, St. Olavs University Hospital, 7030 Trondheim, NorwayDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, B-1070 Brussels, BelgiumECMO Centre Karolinska, Karolinska University Hospital, 171 64 Stockholm, SwedenUOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 1, Fondazione I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, ItalyDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, B-1070 Brussels, BelgiumSan Raffaele Scientific Institute, Vita Salute University, 20132 Milan, ItalyDepartment of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, GermanyMultiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five ECMO centers included 300 patients on VA and 329 on VV ECMO support (March 2008 to November 2016). Different prognostic scores were compared between survivors and non-survivors: APACHE II, SOFA, SAPS II in all patients; SAVE, modified SAVE and MELD-XI in VA ECMO; RESP, PRESET, ROCH and PRESERVE in VV ECMO. Model performance was compared using receiver-operating-curve analysis and assessment of model calibration. Survival was assessed at intensive care unit discharge. Results: The main indication for VA ECMO was cardiogenic shock; overall survival was 51%. ICU survivors had higher Glasgow Coma Scale scores and pH, required cardiopulmonary resuscitation (CPR) less frequently, had lower lactate levels and shorter ventilation time pre-ECMO at baseline. The best discrimination between survivors and non-survivors was observed with the SAPS II score (area under the curve [AUC] of 0.73 (95% CI 0.67–0.78)). The main indication for VV ECMO was pneumonia; overall survival was 60%. Lower PaCO<sub>2</sub>, higher pH, lower lactate and lesser need for CPR were observed among survivors. The best discrimination between survivors and non-survivors was observed with the PRESET score (AUC 0.66 (95% CI 0.60–0.72)). Conclusion: The prognostic performance of most scores was moderate in ECMO patients. The use of such scores to decide about ECMO implementation in potential candidates should be discouraged.https://www.mdpi.com/2077-0375/11/2/84ECMOscoreRESP scoreSAVE scorevalidationECLS |
| spellingShingle | Christoph Fisser Luis Alberto Rincon-Gutierrez Tone Bull Enger Fabio Silvio Taccone Lars Mikael Broman Mirko Belliato Leda Nobile Federico Pappalardo Maximilian V. Malfertheiner Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study Membranes ECMO score RESP score SAVE score validation ECLS |
| title | Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study |
| title_full | Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study |
| title_fullStr | Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study |
| title_full_unstemmed | Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study |
| title_short | Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study |
| title_sort | validation of prognostic scores in extracorporeal life support a multi centric retrospective study |
| topic | ECMO score RESP score SAVE score validation ECLS |
| url | https://www.mdpi.com/2077-0375/11/2/84 |
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