Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock
Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality i...
| Principais autores: | , , , , , , , |
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| Formato: | Artigo |
| Idioma: | English |
| Publicado em: |
Korean Society for Thoracic & Cardiovascular Surgery
2023-07-01
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| coleção: | Journal of Chest Surgery |
| Assuntos: |
| _version_ | 1827908011788599296 |
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| author | Jae Beom Jeon Cho Hee Lee Yongwhan Lim Min-Chul Kim Hwa Jin Cho Do Wan Kim Kyo Seon Lee In Seok Jeong |
| author_facet | Jae Beom Jeon Cho Hee Lee Yongwhan Lim Min-Chul Kim Hwa Jin Cho Do Wan Kim Kyo Seon Lee In Seok Jeong |
| author_sort | Jae Beom Jeon |
| collection | DOAJ |
| description | Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO. Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared. Results: Patients’ mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11–0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63–0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001). Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.
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| first_indexed | 2024-03-13T01:15:06Z |
| format | Article |
| id | doaj.art-ee5a6ea633d84f28b1353e44f08a029c |
| institution | Directory Open Access Journal |
| issn | 2765-1606 2765-1614 |
| language | English |
| last_indexed | 2024-03-13T01:15:06Z |
| publishDate | 2023-07-01 |
| publisher | Korean Society for Thoracic & Cardiovascular Surgery |
| record_format | Article |
| series | Journal of Chest Surgery |
| spelling | doaj.art-ee5a6ea633d84f28b1353e44f08a029c2023-07-05T11:25:39ZengKorean Society for Thoracic & Cardiovascular SurgeryJournal of Chest Surgery2765-16062765-16142023-07-0156424425110.5090/jcs.22.130Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic ShockJae Beom Jeon0https://orcid.org/0000-0001-7697-1880Cho Hee Lee1https://orcid.org/0000-0001-9271-9650Yongwhan Lim2https://orcid.org/0000-0002-2405-1676Min-Chul Kim3https://orcid.org/0000-0001-6026-1702Hwa Jin Cho4https://orcid.org/0000-0002-2458-8529Do Wan Kim5https://orcid.org/0000-0003-2262-2882Kyo Seon Lee6https://orcid.org/0000-0001-7397-4680In Seok Jeong7https://orcid.org/0000-0002-2249-0667Chonnam National University Medical SchoolChonnam National University Medical SchoolChonnam National University Medical SchoolChonnam National University Medical SchoolChonnam National University Medical SchoolChonnam National University Medical SchoolChonnam National University Medical SchoolChonnam National University Medical SchoolBackground: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO. Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared. Results: Patients’ mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11–0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63–0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001). Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO. albuminextracorporeal membrane oxygenationcardiogenic shock |
| spellingShingle | Jae Beom Jeon Cho Hee Lee Yongwhan Lim Min-Chul Kim Hwa Jin Cho Do Wan Kim Kyo Seon Lee In Seok Jeong Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock Journal of Chest Surgery albumin extracorporeal membrane oxygenation cardiogenic shock |
| title | Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock |
| title_full | Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock |
| title_fullStr | Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock |
| title_full_unstemmed | Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock |
| title_short | Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock |
| title_sort | hypoalbuminemia and albumin replacement during extracorporeal membrane oxygenation in patients with cardiogenic shock |
| topic | albumin extracorporeal membrane oxygenation cardiogenic shock |
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