Prognosis of patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation: The impact of urine output on mortality

Ching Chung Hsiao, Chih Hsiang Chang, Pei Chun Fan, Heng Tsan Ho, Chang Chyi Jenq, Kuo Chin Kao, Li Chung Chiu, Shen Yang Lee, Hsiang Hao Hsu, Ya Chung Tian, Cheng Chieh Hung, Ji Tseng Fang, Chih Wei Yang, Feng Chun Tsai, Yung Chang Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

28 Scopus citations

Abstract

Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. Methods This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. Results The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. Conclusions In ARDS patients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.

Original languageEnglish
Pages (from-to)1939-1944
Number of pages6
JournalAnnals of Thoracic Surgery
Volume97
Issue number6
DOIs
StatePublished - 06 2014

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