The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-01-29

AUTHORS

Grégoire Muller, Erwan Flecher, Guillaume Lebreton, Charles-Edouard Luyt, Jean-Louis Trouillet, Nicolas Bréchot, Matthieu Schmidt, Ciro Mastroianni, Jean Chastre, Pascal Leprince, Amedeo Anselmi, Alain Combes

ABSTRACT

PurposeThis study was designed to identify factors associated with in-intensive care unit (ICU) death and develop a practical mortality risk score for venoarterial-extracorporeal membrane oxygenation (VA-ECMO)-treated acute myocardial infarction (AMI) patients. Long-term survivors’ health-related quality of life (HRQOL), anxiety, depression, and post-traumatic stress disorder (PTSD) frequencies were also assessed.MethodsData from 138 ECMO-treated AMI patients admitted to two French ICUs (2008–2013) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQOL, psychological and PTSD status.ResultsSixty-five patients (47 %) survived to ICU discharge. On the basis of multivariable logistic regression analyses, the ENCOURAGE score was constructed with seven pre-ECMO parameters: age >60, female sex, body mass index >25 kg/m2, Glasgow coma score <6, creatinine >150 μmol/L, lactate (<2, 2–8, or >8 mmol/L), and prothrombin activity <50 %. Six months after ECMO, probabilities of survival were 80, 58, 25, 20, and 7 % for ENCOURAGE score classes 0–12, 13–18, 19–22, 23–27, and ≥28, respectively. The ENCOURAGE score ROC AUC [0.84 (95 % CI 0.77–0.91)] was significantly better than those of the SAVE, SAPS II, and SOFA scores. Survivors’ HRQOL evaluated after median follow-up of 32 months revealed satisfactory mental health but persistent physical and emotional-related difficulties, with 34 % (95 % CI 20–49 %) anxiety, 20 % (95 % CI 8–32 %) depression, and 5 % (95 % CI 0–12 %) PTSD symptoms reported.ConclusionsThe ENCOURAGE score might be a useful tool to predict mortality of severe cardiogenic shock AMI patients who received VA-ECMO. However, it now needs prospective validation on other populations of AMI patients. More... »

PAGES

370-378

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-016-4223-9

DOI

http://dx.doi.org/10.1007/s00134-016-4223-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1042967215

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26825953


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    "description": "PurposeThis study was designed to identify factors associated with in-intensive care unit (ICU) death and develop a practical mortality risk score for venoarterial-extracorporeal membrane oxygenation (VA-ECMO)-treated acute myocardial infarction (AMI) patients. Long-term survivors\u2019 health-related quality of life (HRQOL), anxiety, depression, and post-traumatic stress disorder (PTSD) frequencies were also assessed.MethodsData from 138 ECMO-treated AMI patients admitted to two French ICUs (2008\u20132013) were analyzed. ICU survivors contacted >6\u00a0months post-ICU discharge were assessed for HRQOL, psychological and PTSD status.ResultsSixty-five patients (47\u00a0%) survived to ICU discharge. On the basis of multivariable logistic regression analyses, the ENCOURAGE score was constructed with seven pre-ECMO parameters: age >60, female sex, body mass index >25\u00a0kg/m2, Glasgow coma score <6, creatinine >150\u00a0\u03bcmol/L, lactate (<2, 2\u20138, or >8\u00a0mmol/L), and prothrombin activity <50\u00a0%. Six months after ECMO, probabilities of survival were 80, 58, 25, 20, and 7\u00a0% for ENCOURAGE score classes 0\u201312, 13\u201318, 19\u201322, 23\u201327, and \u226528, respectively. The ENCOURAGE score ROC AUC [0.84 (95\u00a0% CI 0.77\u20130.91)] was significantly better than those of the SAVE, SAPS\u00a0II, and SOFA scores. Survivors\u2019 HRQOL evaluated after median follow-up of 32\u00a0months revealed satisfactory mental health but persistent physical and emotional-related difficulties, with 34\u00a0% (95\u00a0% CI 20\u201349\u00a0%) anxiety, 20\u00a0% (95\u00a0% CI 8\u201332\u00a0%) depression, and 5\u00a0% (95\u00a0% CI 0\u201312\u00a0%) PTSD symptoms reported.ConclusionsThe ENCOURAGE score might be a useful tool to predict mortality of severe cardiogenic shock AMI patients who received VA-ECMO. However, it now needs prospective validation on other populations of AMI patients.", 
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