Objective To explore the clinical value of dynamic monitoring of blood phosphorus levels in evaluating the prognosis of patients treated with VA-extracorporeal membrane oxygenation (VA-ECMO).Methods The clinical data of 118 patients who received VA-ECMO treatment in the emergency care ward of Jiangsu People's Hospital from May 2020 to September 2023 were retrospectively collected,and the patients were divided into a survival group and a death group according to the prognosis after 28 days of treatment.Monitoring demographic data,clinical data,as well as serum phosphate levels and changes on the day of VA-ECMO)initiation,and on the 1st,2nd,and 3rd days,to analyze the risk factors of survival in VA-ECMO patients.The optimal cut-off value for the risk score based on serum phosphate was determined using the 'surv_cutpoint' function in R software.This function optimized the significance of the split between Kaplan-Meier survival curves and analyzed the predictive value of serum phosphate for short-term survival rates in patients.Results Among 118 patients,there were 68 cases in the survival group(57.63％) and 50 cases in the death group(42.37％).Compared with the death group,the survival group had a longer ECMO conversion time and extended ICU stay,showing statistically significant differences (P<0.05).The blood phosphorus levels on the first day of admission and the percentage compared to baseline values in the death group were significantly lower than those in the survival group (0.81 mmol/L vs.0.93 mmol/L,0.30％ vs.0.15％,respectively,P<0.05).Logistic regression analysis showed that hypophosphatemia on the day of ECMO initiation and on the first day after ECMO initiation was an independent risk factor for poor prognosis in VA-ECMO patients(P=0.042,0.004).The 'surv_cutpoint' function in the R software determined the optimal cutoff value for blood phosphorus to be 0.84 mmol/L.Based on this,patients were divided into a low phosphorus group(≤0.84 mmol/L) and a non-low phosphorus group (>0.84 mmol/L).The 28-day survival rate in the non-low phosphorus group was significantly higher than that in the low phosphorus group(P=0.0076).Conclusions Serum phosphate levels,especially on the first day after ECMO initiation,can serve as an independent risk factor affecting the prognosis of VA-ECMO patients.Clinically,dynamic monitoring of blood phosphate levels should be conducted to assess the prognosis of patients at early stage.
维普
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