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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery

Authors: Christian Roth, Lore Schrutka, Christina Binder, Lukas Kriechbaumer, Gottfried Heinz, Irene M. Lang, Gerald Maurer, Herbert Koinig, Barbara Steinlechner, Alexander Niessner, Klaus Distelmaier, Georg Goliasch

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Extracorporeal membrane oxygenation (ECMO) represents a valuable and rapidly evolving therapeutic option in patients with severe heart or lung failure following cardiovascular surgery. However, despite significant advances in ECMO techniques and management, prognosis remains poor and accurate risk stratification challenging. We therefore evaluated the predictive value of liver function variables on all-cause mortality in patients undergoing venoarterial ECMO support after cardiovascular surgery.

Methods

We included into our single-center registry a total of 240 patients undergoing venoarterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center.

Results

The median follow-up was 37 months (interquartile range 19–67 months), and a total of 156 patients (65 %) died. Alkaline phosphatase and total bilirubin were the strongest predictors for 30-day mortality, with adjusted hazard ratios (HRs) per 1–standard deviation increase of 1.36 (95 % confidence interval [CI] 1.10–1.68; P = 0.004) and 1.22 (95 % CI 1.07–1.40; P = 0.004), respectively. The observed associations persisted for long-term mortality, with adjusted HRs of 1.27 (95 % CI 1.03–1.56; P = 0.023) for alkaline phosphatase and 1.22 (95 % CI 1.07–1.39; P = 0.003) for total bilirubin.

Conclusions

The present study demonstrates that elevated values of alkaline phosphatase and total bilirubin are sensitive parameters for predicting the short-term and long-term outcomes of ECMO patients.
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Literature
1.
Paden ML, Conrad SA, Rycus PT, Thiagarajan RR, Registry ELSO. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J. 2013;59(3):202–10.CrossRefPubMed
2.
Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36(5):1404–11.CrossRefPubMed
3.
Distelmaier K, Winter MP, Rutzler K, Heinz G, Lang IM, Maurer G, et al. Serum butyrylcholinesterase predicts survival after extracorporeal membrane oxygenation after cardiovascular surgery. Crit Care. 2014;18:R24.CrossRefPubMedPubMedCentral
4.
Luo XJ, Wang W, Hu SS, Sun HS, Gao HW, Long C, et al. Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients. Interact Cardiovasc Thorac Surg. 2009;9(2):296–300.CrossRefPubMed
5.
Rastan AJ, Lachmann N, Walther T, Doll N, Gradistanac T, Gommert JF, et al. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs. 2006;29(12):1121–31.PubMed
6.
Formica F, Avalli L, Colagrande L, Ferro O, Greco G, Maggioni E, et al. Extracorporeal membrane oxygenation to support adult patients with cardiac failure: predictive factors of 30-day mortality. Interact Cardiovasc Thorac Surg. 2010;10(5):721–6.CrossRefPubMed
7.
Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139(2):302–11.e1.CrossRefPubMed
8.
Brienza N, Dalfino L, Cinnella G, Diele C, Bruno F, Fiore T. Jaundice in critical illness: promoting factors of a concealed reality. Intensive Care Med. 2006;32(2):267–74.CrossRefPubMed
9.
Koch A, Horn A, Duckers H, Yagmur E, Sanson E, Bruensing J, et al. Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU. Crit Care. 2011;15:R266.CrossRefPubMedPubMedCentral
10.
Nikolaou M, Parissis J, Yilmaz MB, Seronde MF, Kivikko M, Laribi S, et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J. 2013;34(10):742–9.CrossRefPubMed
11.
Kramer L, Jordan B, Druml W, Bauer P, Metnitz PG, Austrian Epidemiologic Study on Intensive Care, ASDI Study Group. Incidence and prognosis of early hepatic dysfunction in critically ill patients – a prospective multicenter study. Crit Care Med. 2007;35(4):1099–104.CrossRefPubMed
12.
Thomson SJ, Cowan ML, Johnston I, Musa S, Grounds M, Rahman TM. ‘Liver function tests’ on the intensive care unit: a prospective, observational study. Intensive Care Med. 2009;35(8):1406–11.CrossRefPubMed
13.
Birrer R, Takuda Y, Takara T. Hypoxic hepatopathy: pathophysiology and prognosis. Intern Med. 2007;46(14):1063–70.CrossRefPubMed
14.
15.
16.
Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013;15(3):172–8.PubMed
17.
Distelmaier K, Niessner A, Haider D, Lang IM, Heinz G, Maurer G, et al. Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery. Intensive Care Med. 2013;39(8):1444–51.CrossRefPubMed
18.
Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31(10):1345–55.CrossRefPubMedPubMedCentral
19.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.CrossRefPubMed
20.
Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15(6):816–23.CrossRefPubMed
21.
Fuhrmann V, Madl C, Mueller C, Holzinger U, Kitzberger R, Funk GC, et al. Hepatopulmonary syndrome in patients with hypoxic hepatitis. Gastroenterology. 2006;131(1):69–75.CrossRefPubMed
22.
Smedira NG, Blackstone EH. Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg. 2001;71(3 Suppl):S60–6, discussion S82–5.CrossRefPubMed
23.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.CrossRefPubMed
24.
Lefering R, Goris RJ, van Nieuwenhoven EJ, Neugebauer E. Revision of the multiple organ failure score. Langenbecks Arch Surg. 2002;387(1):14–20.CrossRefPubMed
25.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.CrossRefPubMed
26.
Møller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013;34(36):2804–11.CrossRefPubMed
27.
Koskinas J, Gomatos IP, Tiniakos DG, Memos N, Boutsikou M, Garatzioti A, et al. Liver histology in ICU patients dying from sepsis: a clinico-pathological study. World J Gastroenterol. 2008;14(9):1389–93.CrossRefPubMedPubMedCentral
28.
Poelzl G, Ess M, Von der Heidt A, Rudnicki M, Frick M, Ulmer H. Concomitant renal and hepatic dysfunctions in chronic heart failure: clinical implications and prognostic significance. Eur J Intern Med. 2013;24(2):177–82.CrossRefPubMed
29.
Allen LA, Felker GM, Pocock S, McMurray JJ, Pfeffer MA, Swedberg K, et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur J Heart Fail. 2009;11(2):170–7.CrossRefPubMedPubMedCentral
30.
Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A, et al. Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients. Intensive Care Med. 2009;35(8):1397–405.CrossRefPubMed
31.
Myers RP, Cerini R, Sayegh R, Moreau R, Degott C, Lebrec D, et al. Cardiac hepatopathy: clinical, hemodynamic, and histologic characteristics and correlations. Hepatology. 2003;37(2):393–400.CrossRefPubMed
32.
Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A, et al. Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med. 2011;37(8):1302–10.CrossRefPubMed
33.
Lau GT, Tan HC, Kritharides L. Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation. Am J Cardiol. 2002;90(12):1405–9.CrossRefPubMed
34.
Butterworth JF, Legault C, Royster RL, Hammon Jr JW. Factors that predict the use of positive inotropic drug support after cardiac valve surgery. Anesth Analg. 1998;86(3):461–7.PubMed
35.
Gillies M, Bellomo R, Doolan L, Buxton B. Bench-to-bedside review: inotropic drug therapy after adult cardiac surgery – a systematic literature review. Crit Care. 2005;9(3):266–79.CrossRefPubMedPubMedCentral
36.
37.
Bellomo R, Auriemma S, Fabbri A, D’Onofrio A, Katz N, McCullough PA, et al. The pathophysiology of cardiac surgery-associated acute kidney injury (CSA-AKI). Int J Artif Organs. 2008;31(2):166–78.PubMed
38.
Keckler SJ, Laituri CA, Ostlie DJ, St Peter SD. A review of venovenous and venoarterial extracorporeal membrane oxygenation in neonates and children. Eur J Pediatr Surg. 2010;20(1):1–4.CrossRefPubMed
39.
Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth. 2000;85(4):599–610.CrossRefPubMed
40.
Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, et al. Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail. 2012;14(3):302–11.CrossRefPubMed
41.
Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, et al. The Fourth INTERMACS Annual Report: 4,000 implants and counting. J Heart Lung Transplant. 2012;31(2):117–26.CrossRefPubMed
Metadata
Title
Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery
Authors
Christian Roth
Lore Schrutka
Christina Binder
Lukas Kriechbaumer
Gottfried Heinz
Irene M. Lang
Gerald Maurer
Herbert Koinig
Barbara Steinlechner
Alexander Niessner
Klaus Distelmaier
Georg Goliasch
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1242-4

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