Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. ECMO
2.3. Data Collection
2.4. Statistical Analysis and Propensity Matching
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Non-Survivors | Survivors | Test Statistic | |
---|---|---|---|
(N = 11) | (N = 7) | ||
Baseline/ICU admission | |||
Age | 55.2 58.0 59.0 | 37.0 47.0 54.7 | F1,16 = 13.18, p < 0.01 3 |
BMI | 25.9 30.0 35.3 | 22.7 26.5 33.3 | F1,8 = 0.54, p = 0.48 3 |
Sex: F/M | 0.1 1/11 | 0.7 5/7 | Χ21 = 7.48, p = 0.01 2 |
SOFA | 2.2 3.0 4.0 | 2.0 4.0 4.0 | F1,16 = 0.01, p = 0.93 3 |
CCI | 1.0 1.0 1.8 | 1.0 1.0 1.0 | F1,16 = 0.34, p = 0.57 3 |
P/F (mmHg) | 59.0 67.0 109.0 | 71.7 82.5 116.1 | F1,15 = 0.48, p = 0.50 3 |
CRP (mg/L) | 57.1 101.9 136.8 | 97.0 156.9 185.9 | F1,16 = 3.16, p = 0.09 3 |
PCT (µg/L) | 0.1 0.1 0.3 | 0.2 0.7 2.4 | F1,15 = 6.07, p = 0.03 3 |
WBC (×109/L) | 10.2 13.5 15.0 | 10.8 13.9 20.5 | F1,16 = 0.73, p = 0.41 3 |
Neutrophil (%) | 89.1 92.8 93.7 | 84.9 91.8 92.6 | F1,15 = 0.81, p = 0.38 3 |
Lymphocyte (%) | 2.6 4.2 6.1 | 3.9 4.6 6.4 | F1,15 = 0.41, p = 0.53 3 |
NLR | 14.8 22.1 36.8 | 14.3 20.1 22.0 | F1,15 = 0.63, p = 0.44 3 |
Ferritin (µg/L) | 727.2 1054.0 1704.4 | 328.3 709.5 1794.7 | F1,12 = 0.80, p = 0.39 3 |
IL-6 (ng/L) | 26.5 50.7 126.6 | 20.1 24.5 46.4 | F1,11 = 1.42, p = 0.26 3 |
D-dimer (mg/L) | 0.8 3.2 4.4 | 1.5 4.4 4.5 | F1,15 = 3.06, p = 0.10 3 |
Lactate (mmol/L) | 3.7 3.7 3.7 | 0.9 1.1 1.4 | F1,1 = 3.00, p = 0.33 3 |
GFR (mL/min/1.73 m2) | 96.8 108.6 117.0 | 103.8 112.3 117.7 | F1,16 = 0.24, p = 0.63 3 |
Treatment | |||
Corticosteroids | 11/11 | 7/7 | N/A |
Remdesivir | 11/11 | 7/7 | N/A |
Tocilizumab | 1/11 | 1/7 | Χ21 = 0.12, p = 0.73 2 |
Hemadsorption | 4/11 | 4/7 | Χ21 = 0.75, p = 0.38 2 |
Before ECMO initiation | |||
P/F (mmHg) | 43.3 69.0 93.3 | 61.2 69.0 81.7 | F1,16 = 0.12, p = 0.73 3 |
pCO2 (kPa) | 13.4 15.3 18.7 | 7.4 9.5 10.9 | F1,16 = 9.19, p = 0.01 3 |
Murray score | 3.7 3.8 4.0 | 3.3 3.5 3.7 | F1,16 = 9.30, p = 0.01 3 |
CRP (mg/L) | 111.5 154.8 215.3 | 113.6 127.5 163.0 | F1,16 = 0.39, p = 0.54 3 |
PCT (µg/L) | 0.4 1.1 4.8 | 0.2 0.7 1.3 | F1,16 = 0.58, p = 0.46 3 |
WBC (×109/L) | 16.5 18.6 22.5 | 13.8 14.6 17.8 | F1,16 = 5.17, p = 0.04 3 |
Neutrophil (%) | 84.4 89.7 95.0 | 84.5 88.9 93.7 | F1,14 = 0.27, p = 0.61 3 |
Lymphocyte (%) | 1.4 3.3 7.2 | 3.2 4.7 8.5 | F1,14 = 0.62, p = 0.45 3 |
NLR | 12.0 27.2 71.0 | 10.6 19.4 28.8 | F1,14 = 0.61, p = 0.45 3 |
Ferritin (µg/L) | 786.3 1280.5 1800.7 | 100.2 352.0 454.3 | F1,9 = 27.00, p < 0.01 3 |
IL-6 (ng/L) | 83.0 542.2 1104.6 | 33.3 53.8 1258.0 | F1,8 = 0.61, p = 0.46 3 |
D-dimer (mg/L) | 2.3 4.3 4.4 | 3.4 4.2 4.6 | F1,12 = 0.33, p = 0.58 3 |
Lactate (mmol/L) | 1.2 1.9 2.8 | 1.5 2.1 2.8 | F1,8 = 0.00, p = 1.00 3 |
GFR (mL/min/1.73 m2) | 45.4 89.2 100.8 | 104.8 114.1 130.1 | F1,16 = 7.31, p = 0.02 3 |
ECMO | Conventional IMV | p | |
---|---|---|---|
(N = 18) | (N = 20) | ||
Age (years) | 55.5 (50–58) | 53 (46.5–58) | 0.557 3 |
Gender (F/M) | 6/12 | 8/12 | 0.671 2 |
BMI (kg/m2) | 30.6 ± 8.5 | 35.5 ± 6.8 | 0.223 3 |
Arterial hypertension (Y/N) | 7/11 | 10/10 | 0.492 2 |
Diabetes mellitus (Y/N) | 1/17 | 2/18 | 0.612 2 |
ESRD (Y/N) | 1/17 | 0/20 | 0.285 2 |
Hematologic disease (Y/N) | 1/17 | 0/20 | 0.285 2 |
CCI | 1 (1–1) | 1 (1–1) | 0.169 3 |
COVID days before ICU admission | 11 (9–14) | 5 (3–9) | <0.001 3 |
SOFA | 3.5 (2–4) | 3.5 (2–4) | 0.765 3 |
PaO2/FiO2 (mmHg) | 77 (64–105) | 71 (52–109) | 0.604 3 |
Ferritin (µg/L) | 933 (637–1716) | 622 (457–2036) | 0.582 3 |
D-dimer (mg/L) | 4.37 (0.94–4.45) | 4.24 (1.38–4.47) | 0.324 3 |
CRP (mg/L) | 120 (91–144) | 91 (66–141) | 0.397 3 |
PCT (ng/mL) | 0.16 (0.11–0.69) | 0.25 (0.15–0.39) | 0.845 3 |
IL-6 (pg/mL) | 43.5 (23.9–52.1) | 39 (21.9–58.4) | 0.856 3 |
Lactate (mmol/L) | 1.99 ± 1.48 | 1.23 ± 0.09 | 0.542 3 |
GFR (mL/min/1.73 m2) | 109.8 (101.1–116.6) | 111.9 (98.1–118.4) | 0.809 3 |
WBC (×109/L) | 13.5 ± 4.3 | 13.5 ± 5.8 | 0.980 3 |
NLR | 20.5 (14.7–26.3) | 19.3 (13.9–26.5) | 0.452 3 |
Variable | ECMO | Conventional IMV | p |
---|---|---|---|
(N = 18) | (N = 20) | ||
Duration of pre-ECMO ventilation (days) | 5.2 ± 4.5 | N/A | N/A |
Duration of ECMO (days) | 11.5 (7–19) | N/A | N/A |
Duration of post-ECMO ventilation (days) | 0 (0–1) | N/A | N/A |
Total duration of ventilation (days) | 17 (13–26) | 8 (6–14) | <0.001 3 |
Corticosteroids | 18/18 | 20/20 | N/A |
Remdesivir | 18/18 | 20/20 | N/A |
Tocilizumab | 2/18 | 2/20 | 0.91 2 |
Neuromuscular blockade | 18 (100%) | 20 (100%) | N/A |
Prone positioning | 7 (38.9%) | 7 (35%) | 0.804 2 |
Duration of ICU stay (days) | 21.5 (17.5–29) | 13 (10–17) | 0.001 3 |
ICU mortality rate | 11 (61.1%) | 8 (40%) | 0.194 2 |
In-hospital mortality rate | 11 (61.1%) | 8 (40%) | 0.194 2 |
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Drmić, Ž.; Bandić, I.; Hleb, S.; Kukoč, A.; Sakan, S.; Sojčić, N.; Kristović, D.; Mikecin, V.; Presečki, I.; Oremuš, Z.Š.; et al. Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia. Diagnostics 2023, 13, 2203. https://doi.org/10.3390/diagnostics13132203
Drmić Ž, Bandić I, Hleb S, Kukoč A, Sakan S, Sojčić N, Kristović D, Mikecin V, Presečki I, Oremuš ZŠ, et al. Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia. Diagnostics. 2023; 13(13):2203. https://doi.org/10.3390/diagnostics13132203
Chicago/Turabian StyleDrmić, Željka, Ivan Bandić, Sonja Hleb, Andrea Kukoč, Sanja Sakan, Nataša Sojčić, Darko Kristović, Verica Mikecin, Ivana Presečki, Zrinka Šafarić Oremuš, and et al. 2023. "Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia" Diagnostics 13, no. 13: 2203. https://doi.org/10.3390/diagnostics13132203