New Prognostic Markers for Patients Undergoing VA-ECMO

Background: The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasing, but mortality and the incidence of severe complications remain high. Valid markers for early outcome assessment are lacking. As systemic inflammation has been shown to be associated with worse outcome, we investigated the neutrophil–lymphocyte ratio (NLR) for early assessment of prognosis in patients undergoing VA-ECMO. Furthermore, the fibrinogen–albumin ratio (FAR) has been suggested as indicator for disease severity during prothrombotic conditions. Thus, we also aimed to assess the predictive value of FAR with respect to thromboembolic complications (TeC) in this cohort.

Method: We retrospectively analyzed data from 344 patients who underwent VA-ECMO therapy due to cardiogenic shock at the University Hospital Duesseldorf, Germany, between 2011 and 2018. Main exposures were baseline FAR and NLR. The primary endpoints were all-cause in-hospital mortality and TeC, respectively. Discrimination of NLR for in-hospital mortality was analyzed by receiver operating characteristics (ROC) curve and the resulting area under the curve (AUC). We followed the same procedure for FAR and TeC. Afterward, we conducted multivariate logistic regression analysis with forced entry of predefined covariables for both parameters of interest.

Results: Investigating NLR, 92 patients were included into final analysis (71.7% male, age 57 ± 14 years). In-hospital mortality rate was 48.9%. ROC curve revealed an AUC of 0.65 (95% confidence interval [CI]: 0.53–0.76) for NLR. Youden index determined a cutoff of 13 for baseline NLR. Binary logistic regression showed an adjusted odds ratio of 3.32 (95% CI: 1.13–9.7).

Investigating FAR, 344 patients were included into analysis (74.7% male, mean age 59 ± 14 years). The in-hospital incidence of TeC was 34%. ROC of FAR for in-hospital TeC revealed an AUC of 0.67 (95% confidence interval [CI]: 0.61–0.74). Youden index determined a cutoff of 130 for baseline FAR. Multivariate logistic regression revealed an adjusted odds ratio of 3.72 (95% CI: 2.26–6.14) for the association between FAR and TeC.

Conclusion: NLR is independently associated with in-hospital mortality and baseline FAR is independently associated with in-hospital TeC in patients undergoing VA-ECMO. Thus, we could identify two new potential biomarkers which might contribute to early prognosis and outcome assessment in this cohort.

Publication History

Article published online:
03 February 2022