Validation of SAVE score and the value of serum lactate in patients admitted for cardiogenic shock treated with VA-ECMO
Abstract Introduction Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option to provide circulatory and pulmonary support to patients with cardiogenic shock. However, a risk profile assessment is essential for an adequate selection of patients for this type of therapy. The...
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| Veröffentlicht in: | European heart journal 2023-11, Vol.44 (Supplement_2) |
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| creator | Presume, J Gomes, D A Albuquerque, F Lopes, P Bello, A R Brizido, C Strong, C Ferreira, J Mendes, M Neves, J P Tralhao, A |
| description | Abstract
Introduction
Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option to provide circulatory and pulmonary support to patients with cardiogenic shock. However, a risk profile assessment is essential for an adequate selection of patients for this type of therapy.
The aim of this study was to 1) validate the SAVE score in a Portuguese cohort of patients treated with VA-ECMO due to cardiogenic shock; 2) evaluate the prognostic impact of the maximum serum lactate level pre-VA-ECMO implantation; 3) assess the ability of lactate to improve risk stratification by the SAVE score.
Methods
We conducted a single-center retrospective analysis of patients treated with VA-ECMO due to cardiogenic shock from 2017 until 2022. Variable assessments were considered before VA-ECMO implantation. The primary outcome analyzed was in-hospital mortality.
Results
A total of 61 patients were included (52±12 years, 74% male, 40% with acute myocardial infarction, 54% with an ejection fraction |
| doi_str_mv | 10.1093/eurheartj/ehad655.1582 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_eurheartj_ehad655_1582</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehad655.1582</oup_id><sourcerecordid>10.1093/eurheartj/ehad655.1582</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1372-3ca4f446cd2860b78ce521430fa47908504d9ce8348b715e10e0f99b0e3d4d7a3</originalsourceid><addsrcrecordid>eNqNkL1OwzAURi0EEqXwCsgvkNZObCcZq6r8SEUdgIoturVviEsaV7ZDxdvTqBUz0zccnW84hNxzNuGszKbY-wbBx-0UGzBKygmXRXpBRlymaVIqIS_JiPFSJkoVH9fkJoQtY6xQXI3IYQ2tNRCt66ir6etsvaBBO48UOkNjg_Qb2h4HFtD3O9qCjhCR2o7ujxp2MVAwOxsjGlo7TzV4Y90ndlbT0Dj9RaNHGOjBxoauZ8li_rK6JVc1tAHvzjsm7w-Lt_lTslw9Ps9ny0TzLE-TTIOohVDapIVim7zQKFMuMlaDyEtWSCZMqbHIRLHJuUTOkNVluWGYGWFyyMZEnX61dyF4rKu9tzvwPxVn1ZCv-stXnfNVQ76jyE-i6_f_dX4BY4h5DQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Validation of SAVE score and the value of serum lactate in patients admitted for cardiogenic shock treated with VA-ECMO</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Presume, J ; Gomes, D A ; Albuquerque, F ; Lopes, P ; Bello, A R ; Brizido, C ; Strong, C ; Ferreira, J ; Mendes, M ; Neves, J P ; Tralhao, A</creator><creatorcontrib>Presume, J ; Gomes, D A ; Albuquerque, F ; Lopes, P ; Bello, A R ; Brizido, C ; Strong, C ; Ferreira, J ; Mendes, M ; Neves, J P ; Tralhao, A</creatorcontrib><description>Abstract
Introduction
Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option to provide circulatory and pulmonary support to patients with cardiogenic shock. However, a risk profile assessment is essential for an adequate selection of patients for this type of therapy.
The aim of this study was to 1) validate the SAVE score in a Portuguese cohort of patients treated with VA-ECMO due to cardiogenic shock; 2) evaluate the prognostic impact of the maximum serum lactate level pre-VA-ECMO implantation; 3) assess the ability of lactate to improve risk stratification by the SAVE score.
Methods
We conducted a single-center retrospective analysis of patients treated with VA-ECMO due to cardiogenic shock from 2017 until 2022. Variable assessments were considered before VA-ECMO implantation. The primary outcome analyzed was in-hospital mortality.
Results
A total of 61 patients were included (52±12 years, 74% male, 40% with acute myocardial infarction, 54% with an ejection fraction <20%, and 74% in SCAI stage D pre-implantation). Overall, 38 (62%) died during hospitalization. The mean SAVE score was -1.7±7.2 points, and the median maximum serum lactate before ECMO implantation was 5.8 [2.7; 11.8] mmol/L.
SAVE score showed a statistically significant association (1±5 vs. -4±7; OR 0.872 [0.789; 0.964] per each point increase; p=0.008) and good discriminative power (AUC 0.710; p=0.006) to predict in-hospital mortality. When grouping patients according to this score, 25 (41%) were classified as SAVE risk class I or II, and 36 (59%) as SAVE class III, IV, or V.
Maximum serum lactate before VA-ECMO implantation also showed a significant association (4.5±3.1 vs. 9.6±6.6; OR 1.264 [1.066;1.498] per each 1mmol/l increase; p=0.007) and good discriminative power (AUC 0.771; p=0.001) to predict the primary outcome. The best lactate cut-off to identify high mortality risk was 5 mmol/l with a sensitivity of 74% and a specificity of 76%. Additionally, taking into account this threshold, lactate significantly enhanced the SAVE score group stratification, with a net reclassification improvement of 36.7% (p=0.021).
Conclusion
In this cohort of patients, the SAVE score was significantly associated with in-hospital mortality. Maximum serum lactate before VA-ECMO implantation was a strong predictor of in-hospital mortality and significantly improved SAVE score risk stratification.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehad655.1582</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2023-11, Vol.44 (Supplement_2)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Presume, J</creatorcontrib><creatorcontrib>Gomes, D A</creatorcontrib><creatorcontrib>Albuquerque, F</creatorcontrib><creatorcontrib>Lopes, P</creatorcontrib><creatorcontrib>Bello, A R</creatorcontrib><creatorcontrib>Brizido, C</creatorcontrib><creatorcontrib>Strong, C</creatorcontrib><creatorcontrib>Ferreira, J</creatorcontrib><creatorcontrib>Mendes, M</creatorcontrib><creatorcontrib>Neves, J P</creatorcontrib><creatorcontrib>Tralhao, A</creatorcontrib><title>Validation of SAVE score and the value of serum lactate in patients admitted for cardiogenic shock treated with VA-ECMO</title><title>European heart journal</title><description>Abstract
Introduction
Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option to provide circulatory and pulmonary support to patients with cardiogenic shock. However, a risk profile assessment is essential for an adequate selection of patients for this type of therapy.
The aim of this study was to 1) validate the SAVE score in a Portuguese cohort of patients treated with VA-ECMO due to cardiogenic shock; 2) evaluate the prognostic impact of the maximum serum lactate level pre-VA-ECMO implantation; 3) assess the ability of lactate to improve risk stratification by the SAVE score.
Methods
We conducted a single-center retrospective analysis of patients treated with VA-ECMO due to cardiogenic shock from 2017 until 2022. Variable assessments were considered before VA-ECMO implantation. The primary outcome analyzed was in-hospital mortality.
Results
A total of 61 patients were included (52±12 years, 74% male, 40% with acute myocardial infarction, 54% with an ejection fraction <20%, and 74% in SCAI stage D pre-implantation). Overall, 38 (62%) died during hospitalization. The mean SAVE score was -1.7±7.2 points, and the median maximum serum lactate before ECMO implantation was 5.8 [2.7; 11.8] mmol/L.
SAVE score showed a statistically significant association (1±5 vs. -4±7; OR 0.872 [0.789; 0.964] per each point increase; p=0.008) and good discriminative power (AUC 0.710; p=0.006) to predict in-hospital mortality. When grouping patients according to this score, 25 (41%) were classified as SAVE risk class I or II, and 36 (59%) as SAVE class III, IV, or V.
Maximum serum lactate before VA-ECMO implantation also showed a significant association (4.5±3.1 vs. 9.6±6.6; OR 1.264 [1.066;1.498] per each 1mmol/l increase; p=0.007) and good discriminative power (AUC 0.771; p=0.001) to predict the primary outcome. The best lactate cut-off to identify high mortality risk was 5 mmol/l with a sensitivity of 74% and a specificity of 76%. Additionally, taking into account this threshold, lactate significantly enhanced the SAVE score group stratification, with a net reclassification improvement of 36.7% (p=0.021).
Conclusion
In this cohort of patients, the SAVE score was significantly associated with in-hospital mortality. Maximum serum lactate before VA-ECMO implantation was a strong predictor of in-hospital mortality and significantly improved SAVE score risk stratification.</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqNkL1OwzAURi0EEqXwCsgvkNZObCcZq6r8SEUdgIoturVviEsaV7ZDxdvTqBUz0zccnW84hNxzNuGszKbY-wbBx-0UGzBKygmXRXpBRlymaVIqIS_JiPFSJkoVH9fkJoQtY6xQXI3IYQ2tNRCt66ir6etsvaBBO48UOkNjg_Qb2h4HFtD3O9qCjhCR2o7ujxp2MVAwOxsjGlo7TzV4Y90ndlbT0Dj9RaNHGOjBxoauZ8li_rK6JVc1tAHvzjsm7w-Lt_lTslw9Ps9ny0TzLE-TTIOohVDapIVim7zQKFMuMlaDyEtWSCZMqbHIRLHJuUTOkNVluWGYGWFyyMZEnX61dyF4rKu9tzvwPxVn1ZCv-stXnfNVQ76jyE-i6_f_dX4BY4h5DQ</recordid><startdate>20231109</startdate><enddate>20231109</enddate><creator>Presume, J</creator><creator>Gomes, D A</creator><creator>Albuquerque, F</creator><creator>Lopes, P</creator><creator>Bello, A R</creator><creator>Brizido, C</creator><creator>Strong, C</creator><creator>Ferreira, J</creator><creator>Mendes, M</creator><creator>Neves, J P</creator><creator>Tralhao, A</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20231109</creationdate><title>Validation of SAVE score and the value of serum lactate in patients admitted for cardiogenic shock treated with VA-ECMO</title><author>Presume, J ; Gomes, D A ; Albuquerque, F ; Lopes, P ; Bello, A R ; Brizido, C ; Strong, C ; Ferreira, J ; Mendes, M ; Neves, J P ; Tralhao, A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1372-3ca4f446cd2860b78ce521430fa47908504d9ce8348b715e10e0f99b0e3d4d7a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Presume, J</creatorcontrib><creatorcontrib>Gomes, D A</creatorcontrib><creatorcontrib>Albuquerque, F</creatorcontrib><creatorcontrib>Lopes, P</creatorcontrib><creatorcontrib>Bello, A R</creatorcontrib><creatorcontrib>Brizido, C</creatorcontrib><creatorcontrib>Strong, C</creatorcontrib><creatorcontrib>Ferreira, J</creatorcontrib><creatorcontrib>Mendes, M</creatorcontrib><creatorcontrib>Neves, J P</creatorcontrib><creatorcontrib>Tralhao, A</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Presume, J</au><au>Gomes, D A</au><au>Albuquerque, F</au><au>Lopes, P</au><au>Bello, A R</au><au>Brizido, C</au><au>Strong, C</au><au>Ferreira, J</au><au>Mendes, M</au><au>Neves, J P</au><au>Tralhao, A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of SAVE score and the value of serum lactate in patients admitted for cardiogenic shock treated with VA-ECMO</atitle><jtitle>European heart journal</jtitle><date>2023-11-09</date><risdate>2023</risdate><volume>44</volume><issue>Supplement_2</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Introduction
Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option to provide circulatory and pulmonary support to patients with cardiogenic shock. However, a risk profile assessment is essential for an adequate selection of patients for this type of therapy.
The aim of this study was to 1) validate the SAVE score in a Portuguese cohort of patients treated with VA-ECMO due to cardiogenic shock; 2) evaluate the prognostic impact of the maximum serum lactate level pre-VA-ECMO implantation; 3) assess the ability of lactate to improve risk stratification by the SAVE score.
Methods
We conducted a single-center retrospective analysis of patients treated with VA-ECMO due to cardiogenic shock from 2017 until 2022. Variable assessments were considered before VA-ECMO implantation. The primary outcome analyzed was in-hospital mortality.
Results
A total of 61 patients were included (52±12 years, 74% male, 40% with acute myocardial infarction, 54% with an ejection fraction <20%, and 74% in SCAI stage D pre-implantation). Overall, 38 (62%) died during hospitalization. The mean SAVE score was -1.7±7.2 points, and the median maximum serum lactate before ECMO implantation was 5.8 [2.7; 11.8] mmol/L.
SAVE score showed a statistically significant association (1±5 vs. -4±7; OR 0.872 [0.789; 0.964] per each point increase; p=0.008) and good discriminative power (AUC 0.710; p=0.006) to predict in-hospital mortality. When grouping patients according to this score, 25 (41%) were classified as SAVE risk class I or II, and 36 (59%) as SAVE class III, IV, or V.
Maximum serum lactate before VA-ECMO implantation also showed a significant association (4.5±3.1 vs. 9.6±6.6; OR 1.264 [1.066;1.498] per each 1mmol/l increase; p=0.007) and good discriminative power (AUC 0.771; p=0.001) to predict the primary outcome. The best lactate cut-off to identify high mortality risk was 5 mmol/l with a sensitivity of 74% and a specificity of 76%. Additionally, taking into account this threshold, lactate significantly enhanced the SAVE score group stratification, with a net reclassification improvement of 36.7% (p=0.021).
Conclusion
In this cohort of patients, the SAVE score was significantly associated with in-hospital mortality. Maximum serum lactate before VA-ECMO implantation was a strong predictor of in-hospital mortality and significantly improved SAVE score risk stratification.</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehad655.1582</doi><oa>free_for_read</oa></addata></record> |
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| title | Validation of SAVE score and the value of serum lactate in patients admitted for cardiogenic shock treated with VA-ECMO |
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