Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery

Christian Roth, Lore Schrutka, Christina Binder, Lukas Kriechbaumer, Gottfried Heinz, Irene M Lang, Gerald Maurer, Herbert Koinig, Barbara Steinlechner, Alexander Niessner, Klaus Distelmaier, Georg Goliasch

Research output: Journal article (peer-reviewed)Journal article

43 Citations (Scopus)

Abstract

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) represents a valuable and rapidly evolving therapeutic option in patients with severe heart or lung failure following cardiovascular surgery. However, despite significant advances in ECMO techniques and management, prognosis remains poor and accurate risk stratification challenging. We therefore evaluated the predictive value of liver function variables on all-cause mortality in patients undergoing venoarterial ECMO support after cardiovascular surgery.

METHODS: We included into our single-center registry a total of 240 patients undergoing venoarterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center.

RESULTS: The median follow-up was 37 months (interquartile range 19-67 months), and a total of 156 patients (65%) died. Alkaline phosphatase and total bilirubin were the strongest predictors for 30-day mortality, with adjusted hazard ratios (HRs) per 1-standard deviation increase of 1.36 (95% confidence interval [CI] 1.10-1.68; P = 0.004) and 1.22 (95% CI 1.07-1.40; P = 0.004), respectively. The observed associations persisted for long-term mortality, with adjusted HRs of 1.27 (95% CI 1.03-1.56; P = 0.023) for alkaline phosphatase and 1.22 (95% CI 1.07-1.39; P = 0.003) for total bilirubin.

CONCLUSIONS: The present study demonstrates that elevated values of alkaline phosphatase and total bilirubin are sensitive parameters for predicting the short-term and long-term outcomes of ECMO patients.

Original languageEnglish
Article number57
Pages (from-to)57
JournalCritical Care
Volume20
Issue number1
DOIs
Publication statusPublished - 11 Mar 2016

Keywords

  • Aged
  • Alkaline Phosphatase/analysis
  • Bilirubin/analysis
  • Cardiovascular Surgical Procedures/adverse effects
  • Extracorporeal Membrane Oxygenation/mortality
  • Female
  • Humans
  • Liver/pathology
  • Liver Function Tests/mortality
  • Male
  • Middle Aged
  • Prognosis
  • Respiratory Insufficiency/etiology
  • Survival Analysis
  • Switzerland
  • Alkaline phosphatase
  • Extracorporeal membrane oxygenation
  • Mortality
  • Cardiovascular surgery
  • Bilirubin
  • Liver function
  • Outcome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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