Influencing factors of poor prognosis of severe pneumonia patients after extracorporeal membrane oxygenation therapy
Objective To observe the 28-d survival after extracorporeal membrane oxygenation(ECMO)therapy in patients with severe pneumonia(SP),and to investigate the influencing factors of poor prognosis.Methods The clinical data of 61 SP patients undergoing ECMO therapy in Henan Provincial People's Hospital from January 2018 to June 2023 were retrospectively analyzed.According to the 28-d survival after ECMO therapy,61 patients were divided into survival group(n=37)and death group(n=24).The gender ratio,age,diabetes,hypertension,SP cause(viral infection,bacterial infection,secondary pneumonia),mechanical ventilation time before ECMO therapy,time from ICU admission to ECMO start,and scores of pre-ECMO acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),sequential organ failure assessment(SOFA)and Murray lung injury were compared between two groups.The oxygenation index,arterial blood pH,pa(CO2),mean arterial pressure,respiratory frequency,tidal volume,positive end-expiratory pressure,blood lactic acid,white blood cell count,hemoglobin,procalcitonin,blood creatinine and platelet count were compared between two groups before and after 24-h ECMO therapy.The complications as bleeding,infection,thrombosis,thrombocytopenia and hemolysis were recorded in two groups.Multivariate logistic regression analysis was done to evaluate the influencing factors of 28-d mortality after ECMO therapy in SP patients.Results(1)Before ECMO therapy,the scores of APACHE Ⅱ and Murray lung injury were higher in death group(32.25±6.62,2.86±0.35)than those in survival group(25.46±6.29,2.67±0.31)(t=4.036,P＜0.001;t=2.270,P=0.028),the platelet count was lower in death group[(107.21±40.82)×109/L]than that in survival group[(132.08±48.53)×109/L](t=2.077,P=0.042),the time of mechanical ventilation and time from ICU admission to ECMO start were longer in death group[(4.57±1.17),(5.54±0.85)d]than those in survival group[(2.58±0.88),(3.83±0.46)d](t=7.562,P＜0.001;t=9.050,P＜0.001),and there were no significant differences in the gender ratio,age,diabetes,hypertension,cause of SP,SOFA score,oxygenation index,arterial blood pH,pa(CO2),mean arterial pressure,respiratory frequency,positive end-expiratory pressure,tidal volume,blood lactic acid,white blood cell count,hemoglobin,procalcitonin and blood creatinine between two groups(P＞0.05).(2)After 24-h ECMO therapy,the platelet count was lower in death group[(88.53±25.15)×109/L]than that in survival group[(109.47± 32.47)×109/L](t=2.679,P=0.010),and there were no significant differences in the oxygenation index,mean arterial pressure,arterial blood pH,pa(CO2),respiratory frequency,positive end-expiratory pressure,tidal volume,blood lactic acid,white blood cell count,hemoglobin,procalcitonin and blood creatinine between two groups(P＞0.05).(3)Among 61 patients,ECMO was successfully withdrawn in 40.There was no significant difference in the length of ECMO therapy between survival group[(227.89±168.39)h]and death group[(232.23±131.44)h](P＞0.05).There were no significant differences in the incidence rates of bleeding,infection,thrombosis,thrombocytopenia and hemolysis between two groups during ECMO therapy(P＞0.05).(4)The pre-ECMO APACHE Ⅱ score(OR=1.242,95％CI:1.070-1.442,P=0.004),platelet count after 24-h ECMO therapy(OR=0.959,95％CI:0.927-0.992,P=0.014)and time from ICU admission to ECMO start(OR=1.477,95％CI:1.010-2.160,P=0.044)were the influencing factors of 28-d mortality after ECMO in SP patients.Conclusion The high pre-ECMO APACHE Ⅱ score,long time from ICU admission to ECMO start,and low platelet count after 24-h ECMO therapy indicate a high risk of death in SP patients.
severe pneumoniaextracorporeal membrane oxygenationpoor prognosisrisk factors
NETL
NSTL
万方数据
维普
