Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation.
Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation.
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DOI：
10.3390/jcm7100313
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发表时间：
2018-09-29
影响因子：
3.9
通讯作者：
Chen YS
中科院分区：
文献类型：
--
作者：
Tseng LJ;Yu HY;Wang CH;Chi NH;Huang SC;Chou HW;Shih HC;Chou NK;Chen YS
体外心肺复苏（ECPR）已逐渐被认为是一种有效的治疗方法，但ECPR后的住院死亡率仍然很高且不可预测。本研究旨在探讨年龄调整的Charlson共病指数（ACCI）是否可以作为一个客观的选择标准，以确保最有效地利用医疗资源。纳入了2006年至2015年期间在我们机构接受ECPR的成人患者（年龄≥ 18岁）。在体外膜肺氧合（ECMO）设置后立即收集有关ECPR事件和ACCI特征的数据。还前瞻性收集了住院期间的不良事件。主要终点为出院时的生存率。第二个终点是短期（2年）随访结果。本研究共纳入461例患者，分为低ACCI（ACCI 0-3）（240，52.1%）和高ACCI（ACCI 4-13）（221，47.9%）组。低ACCI组和高ACCI组的中位ACCI分别为2（四分位距（IQR）：1-3）和5（IQR：4-7）。两组之间的心肺复苏（CPR）至ECMO持续时间相当（低ACCI组和高ACCI组分别为42.1 ± 25.6和41.3 ± 20.7分钟; p = 0.754）。关于住院生存率，256例患者（55.5%）在ECMO支持下死亡。共有205例患者（44.5%）成功脱离ECMO，但只有138例患者（29.9%）存活至出院（低ACCI组和高ACCI组分别为32.1%和27.6%，p = 0.291）。多变量logistic回归分析显示，ECMO运行前CPR持续时间（CPR至ECMO持续时间）和CPR导致脓毒性休克是ECPR后住院生存的重要危险因素（分别为p = 0.043和0.014），而年龄和ACCI则不是（分别为p = 0.334和0.164）。低ACCI组和高ACCI组的138名住院幸存者出院后的2年生存率分别为96%和74%（p = 0.002）。ECPR前高ACCI并不预示着医院生存结局差。因此，ECPR不应仅因高ACCI而被拒绝。然而，高ACCI的住院生存者的2年死亡率高于低ACCI，高ACCI患者应密切随访。
Extracorporeal cardiopulmonary resuscitation (ECPR) has gradually come to be regarded as an effective therapy, but the hospital mortality rate after ECPR is still high and unpredictable. The present study tested whether age-adjusted Charlson comorbidity index (ACCI) can be used as an objective selection criterion to ensure the most efficient utilization of medical resources. Adult patients (age ≥ 18 years) receiving ECPR at our institution between 2006 and 2015 were included. Data regarding ECPR events and ACCI characteristics were collected immediately after the extracorporeal membrane oxygenation (ECMO) setup. Adverse events during hospitalization were also prospectively collected. The primary endpoint was survival to hospital discharge. The second endpoint was the short-term (2-year) follow-up outcome. A total of 461 patients included in the study were grouped into low ACCI (ACCI 0–3) (240, 52.1%) and high ACCI (ACCI 4–13) (221, 47.9%) groups. The median ACCI was 2 (interquartile range (IQR): 1–3) and 5 (IQR: 4–7) for the low and high ACCI groups, respectively. Cardiopulmonary resuscitation (CPR)-to-ECMO duration was comparable between the groups (42.1 ± 25.6 and 41.3 ± 20.7 min in the low and high ACCI groups, respectively; p = 0.754). Regarding the hospital survival rate, 256 patients (55.5%) died on ECMO support. A total of 205 patients (44.5%) were successfully weaned off ECMO, but only 138 patients (29.9%) survived to hospital discharge (32.1% and 27.6% in low and high ACCI group, p = 0.291). Multivariate logistic regression analysis revealed CPR duration before ECMO run (CPR-to-ECMO duration) and a CPR cause of septic shock to be significant risk factors for hospital survival after ECPR (p = 0.043 and 0.014, respectively), whereas age and ACCI were not (p = 0.334 and 0.164, respectively). The 2-year survival rate after hospital discharge for the 138 hospital survivors was 96% and 74% in the low and high ACCI groups, respectively (p = 0.002). High ACCI before ECPR does not predict a poor outcome of hospital survival. Therefore, ECPR should not be rejected solely due to high ACCI. However, high ACCI in hospital survivors is associated with a higher 2-year mortality rate than low ACCI, and patients with high ACCI should be closely followed up.
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影响因子：
5
作者：
Jung, Christian;Janssen, Kyra;Figulla, Hans Reiner
通讯作者：
Figulla, Hans Reiner
影响因子：
3.4
作者：
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影响因子：
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影响因子：
168.9
作者：
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通讯作者：
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