Predicting mortality in nonsurgical patients before cannulation for veno‐arterial extracorporeal life support: Development and validation of the LACT‐8 score
Objectives We sought to derive and validate a model to predict inpatient mortality after veno‐arterial extracorporeal life support (VA‐ECLS) based on readily available, precannulation clinical data. Background Refractory cardiogenic shock supported by VA‐ECLS is associated with high morbidity and mo...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2022-03, Vol.99 (4), p.1115-1124 |
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| creator | Hillerson, Dustin Whiteside, Hoyle L. Dugan, Adam J. Coots, Riley D. Tribble, Thomas A. Abdel‐Latif, Ahmed Ogunbayo, Gbolahan O. Duncan, Meredith S. Gupta, Vedant A. |
| description | Objectives
We sought to derive and validate a model to predict inpatient mortality after veno‐arterial extracorporeal life support (VA‐ECLS) based on readily available, precannulation clinical data.
Background
Refractory cardiogenic shock supported by VA‐ECLS is associated with high morbidity and mortality.
Methods
VA‐ECLS cases at our institution from January 2014 through July 2019 were retrospectively reviewed. Exclusion criteria were cannulation: (1) at another institution; (2) for primary surgical indication; or (3) for extracorporeal cardiopulmonary resuscitation. Multivariable logistic regression compared those with and without inpatient mortality. Multiple imputation was performed and optimism‐adjusted area under the curve (oAUC) values were computed.
Results
VA‐ECLS cases from August 2019 through November 2020 were identified as a validation cohort. In the derivation cohort (n = 135), the final model included Lactate (mmol/L), hemoglobin (g/dl; Anemia), Coma (Glasgow Coma Scale [GCS] 8) and hemoglobin ( |
| doi_str_mv | 10.1002/ccd.30106 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2626004330</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2652517500</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3136-db3df01b2ab325e84f65a8bdec0680b625d8d6bf5dfcebb3b1a9685e9868568b3</originalsourceid><addsrcrecordid>eNp1kUtuFDEQhlsIREJgwQWQJTZkMYkfY6ebXdQJD2kkWASJXcuPcnDkthvbPTA7jsAREEfhKJwEhx5YILGxXaXPX5X0N81jgk8IxvRUa3PCMMHiTnNIOKWrMyre392_SbcWB82DnG8wxp2g3f3mgHFC1pjTw-b72wTG6eLCNRpjKtK7skMuoBBDntO109KjSRYHoWSkwMYEP75pGcLsazcGVDtoCyH-_PJVpgLJ1Q_wuSSpY5oqXUvvLKA8T7Usz9EFbMHHaaxGJINB2zrTLK5oUfkAaHPeX1Vdi3J1wMPmnpU-w6P9fdS8e3F51b9abd68fN2fb1aaESZWRjFjMVFUKkY5tGsruGyVAY1Fi5Wg3LRGKMuN1aAUU0R2ouXQtfUUrWJHzbPFO6X4cYZchtFlDd7LAHHOAxVUYLxmDFf06T_oTZxTqNtVilNOzji-pY4XSqeYcwI7TMmNMu0Ggofb4IYa3PA7uMo-2RtnNYL5S_5JqgKnC_DJedj93zT0_cWi_AUjz6hD</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2652517500</pqid></control><display><type>article</type><title>Predicting mortality in nonsurgical patients before cannulation for veno‐arterial extracorporeal life support: Development and validation of the LACT‐8 score</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Hillerson, Dustin ; Whiteside, Hoyle L. ; Dugan, Adam J. ; Coots, Riley D. ; Tribble, Thomas A. ; Abdel‐Latif, Ahmed ; Ogunbayo, Gbolahan O. ; Duncan, Meredith S. ; Gupta, Vedant A.</creator><creatorcontrib>Hillerson, Dustin ; Whiteside, Hoyle L. ; Dugan, Adam J. ; Coots, Riley D. ; Tribble, Thomas A. ; Abdel‐Latif, Ahmed ; Ogunbayo, Gbolahan O. ; Duncan, Meredith S. ; Gupta, Vedant A.</creatorcontrib><description>Objectives
We sought to derive and validate a model to predict inpatient mortality after veno‐arterial extracorporeal life support (VA‐ECLS) based on readily available, precannulation clinical data.
Background
Refractory cardiogenic shock supported by VA‐ECLS is associated with high morbidity and mortality.
Methods
VA‐ECLS cases at our institution from January 2014 through July 2019 were retrospectively reviewed. Exclusion criteria were cannulation: (1) at another institution; (2) for primary surgical indication; or (3) for extracorporeal cardiopulmonary resuscitation. Multivariable logistic regression compared those with and without inpatient mortality. Multiple imputation was performed and optimism‐adjusted area under the curve (oAUC) values were computed.
Results
VA‐ECLS cases from August 2019 through November 2020 were identified as a validation cohort. In the derivation cohort (n = 135), the final model included Lactate (mmol/L), hemoglobin (g/dl; Anemia), Coma (Glasgow Coma Scale [GCS] < 8) and resusciTATEd cardiac arrest (LACTATE score; oAUC = 0.760). In the validation cohort (n = 30, LACTATE showed similar predictability [AUC = 0.710]). A simplified (LACT‐8) score was derived by dichotomizing lactate (>8) and hemoglobin (<8) and summing together the number of components for each patient. LACT‐8 performed similarly (derivation, oAUC = 0.724; validation, AUC = 0.725). In the derivation cohort, both scores outperformed SAVE (oAUC = 0.568) and SOFA (oAUC = 0.699) scores. A LACT‐8 ≥ 3 had a specificity for mortality of 97.9% and 92.9%, in the derivation and validation cohorts, respectively.
Conclusions
The LACT‐8 score can predict inpatient mortality prior to before cannulation for VA‐ECLS. LACT‐8 can be implemented utilizing clinical data without the need for an online calculator.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.30106</identifier><identifier>PMID: 35114052</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Cannulation ; cardiogenic shock ; Catheterization ; Coma ; Extracorporeal membrane oxygenation ; Hemoglobin ; Hospital Mortality ; Humans ; Lactic Acid ; mechanical circulatory support ; Morbidity ; Mortality ; outcome ; Patients ; Retrospective Studies ; Shock, Cardiogenic - diagnosis ; Shock, Cardiogenic - therapy ; Treatment Outcome</subject><ispartof>Catheterization and cardiovascular interventions, 2022-03, Vol.99 (4), p.1115-1124</ispartof><rights>2022 Wiley Periodicals LLC</rights><rights>2022 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3136-db3df01b2ab325e84f65a8bdec0680b625d8d6bf5dfcebb3b1a9685e9868568b3</cites><orcidid>0000-0002-9962-8855</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.30106$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.30106$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35114052$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hillerson, Dustin</creatorcontrib><creatorcontrib>Whiteside, Hoyle L.</creatorcontrib><creatorcontrib>Dugan, Adam J.</creatorcontrib><creatorcontrib>Coots, Riley D.</creatorcontrib><creatorcontrib>Tribble, Thomas A.</creatorcontrib><creatorcontrib>Abdel‐Latif, Ahmed</creatorcontrib><creatorcontrib>Ogunbayo, Gbolahan O.</creatorcontrib><creatorcontrib>Duncan, Meredith S.</creatorcontrib><creatorcontrib>Gupta, Vedant A.</creatorcontrib><title>Predicting mortality in nonsurgical patients before cannulation for veno‐arterial extracorporeal life support: Development and validation of the LACT‐8 score</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objectives
We sought to derive and validate a model to predict inpatient mortality after veno‐arterial extracorporeal life support (VA‐ECLS) based on readily available, precannulation clinical data.
Background
Refractory cardiogenic shock supported by VA‐ECLS is associated with high morbidity and mortality.
Methods
VA‐ECLS cases at our institution from January 2014 through July 2019 were retrospectively reviewed. Exclusion criteria were cannulation: (1) at another institution; (2) for primary surgical indication; or (3) for extracorporeal cardiopulmonary resuscitation. Multivariable logistic regression compared those with and without inpatient mortality. Multiple imputation was performed and optimism‐adjusted area under the curve (oAUC) values were computed.
Results
VA‐ECLS cases from August 2019 through November 2020 were identified as a validation cohort. In the derivation cohort (n = 135), the final model included Lactate (mmol/L), hemoglobin (g/dl; Anemia), Coma (Glasgow Coma Scale [GCS] < 8) and resusciTATEd cardiac arrest (LACTATE score; oAUC = 0.760). In the validation cohort (n = 30, LACTATE showed similar predictability [AUC = 0.710]). A simplified (LACT‐8) score was derived by dichotomizing lactate (>8) and hemoglobin (<8) and summing together the number of components for each patient. LACT‐8 performed similarly (derivation, oAUC = 0.724; validation, AUC = 0.725). In the derivation cohort, both scores outperformed SAVE (oAUC = 0.568) and SOFA (oAUC = 0.699) scores. A LACT‐8 ≥ 3 had a specificity for mortality of 97.9% and 92.9%, in the derivation and validation cohorts, respectively.
Conclusions
The LACT‐8 score can predict inpatient mortality prior to before cannulation for VA‐ECLS. LACT‐8 can be implemented utilizing clinical data without the need for an online calculator.</description><subject>Cannulation</subject><subject>cardiogenic shock</subject><subject>Catheterization</subject><subject>Coma</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Hemoglobin</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Lactic Acid</subject><subject>mechanical circulatory support</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>outcome</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Shock, Cardiogenic - diagnosis</subject><subject>Shock, Cardiogenic - therapy</subject><subject>Treatment Outcome</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtuFDEQhlsIREJgwQWQJTZkMYkfY6ebXdQJD2kkWASJXcuPcnDkthvbPTA7jsAREEfhKJwEhx5YILGxXaXPX5X0N81jgk8IxvRUa3PCMMHiTnNIOKWrMyre392_SbcWB82DnG8wxp2g3f3mgHFC1pjTw-b72wTG6eLCNRpjKtK7skMuoBBDntO109KjSRYHoWSkwMYEP75pGcLsazcGVDtoCyH-_PJVpgLJ1Q_wuSSpY5oqXUvvLKA8T7Usz9EFbMHHaaxGJINB2zrTLK5oUfkAaHPeX1Vdi3J1wMPmnpU-w6P9fdS8e3F51b9abd68fN2fb1aaESZWRjFjMVFUKkY5tGsruGyVAY1Fi5Wg3LRGKMuN1aAUU0R2ouXQtfUUrWJHzbPFO6X4cYZchtFlDd7LAHHOAxVUYLxmDFf06T_oTZxTqNtVilNOzji-pY4XSqeYcwI7TMmNMu0Ggofb4IYa3PA7uMo-2RtnNYL5S_5JqgKnC_DJedj93zT0_cWi_AUjz6hD</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Hillerson, Dustin</creator><creator>Whiteside, Hoyle L.</creator><creator>Dugan, Adam J.</creator><creator>Coots, Riley D.</creator><creator>Tribble, Thomas A.</creator><creator>Abdel‐Latif, Ahmed</creator><creator>Ogunbayo, Gbolahan O.</creator><creator>Duncan, Meredith S.</creator><creator>Gupta, Vedant A.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9962-8855</orcidid></search><sort><creationdate>20220301</creationdate><title>Predicting mortality in nonsurgical patients before cannulation for veno‐arterial extracorporeal life support: Development and validation of the LACT‐8 score</title><author>Hillerson, Dustin ; Whiteside, Hoyle L. ; Dugan, Adam J. ; Coots, Riley D. ; Tribble, Thomas A. ; Abdel‐Latif, Ahmed ; Ogunbayo, Gbolahan O. ; Duncan, Meredith S. ; Gupta, Vedant A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3136-db3df01b2ab325e84f65a8bdec0680b625d8d6bf5dfcebb3b1a9685e9868568b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cannulation</topic><topic>cardiogenic shock</topic><topic>Catheterization</topic><topic>Coma</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Hemoglobin</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Lactic Acid</topic><topic>mechanical circulatory support</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>outcome</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Shock, Cardiogenic - diagnosis</topic><topic>Shock, Cardiogenic - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hillerson, Dustin</creatorcontrib><creatorcontrib>Whiteside, Hoyle L.</creatorcontrib><creatorcontrib>Dugan, Adam J.</creatorcontrib><creatorcontrib>Coots, Riley D.</creatorcontrib><creatorcontrib>Tribble, Thomas A.</creatorcontrib><creatorcontrib>Abdel‐Latif, Ahmed</creatorcontrib><creatorcontrib>Ogunbayo, Gbolahan O.</creatorcontrib><creatorcontrib>Duncan, Meredith S.</creatorcontrib><creatorcontrib>Gupta, Vedant A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hillerson, Dustin</au><au>Whiteside, Hoyle L.</au><au>Dugan, Adam J.</au><au>Coots, Riley D.</au><au>Tribble, Thomas A.</au><au>Abdel‐Latif, Ahmed</au><au>Ogunbayo, Gbolahan O.</au><au>Duncan, Meredith S.</au><au>Gupta, Vedant A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting mortality in nonsurgical patients before cannulation for veno‐arterial extracorporeal life support: Development and validation of the LACT‐8 score</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>99</volume><issue>4</issue><spage>1115</spage><epage>1124</epage><pages>1115-1124</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives
We sought to derive and validate a model to predict inpatient mortality after veno‐arterial extracorporeal life support (VA‐ECLS) based on readily available, precannulation clinical data.
Background
Refractory cardiogenic shock supported by VA‐ECLS is associated with high morbidity and mortality.
Methods
VA‐ECLS cases at our institution from January 2014 through July 2019 were retrospectively reviewed. Exclusion criteria were cannulation: (1) at another institution; (2) for primary surgical indication; or (3) for extracorporeal cardiopulmonary resuscitation. Multivariable logistic regression compared those with and without inpatient mortality. Multiple imputation was performed and optimism‐adjusted area under the curve (oAUC) values were computed.
Results
VA‐ECLS cases from August 2019 through November 2020 were identified as a validation cohort. In the derivation cohort (n = 135), the final model included Lactate (mmol/L), hemoglobin (g/dl; Anemia), Coma (Glasgow Coma Scale [GCS] < 8) and resusciTATEd cardiac arrest (LACTATE score; oAUC = 0.760). In the validation cohort (n = 30, LACTATE showed similar predictability [AUC = 0.710]). A simplified (LACT‐8) score was derived by dichotomizing lactate (>8) and hemoglobin (<8) and summing together the number of components for each patient. LACT‐8 performed similarly (derivation, oAUC = 0.724; validation, AUC = 0.725). In the derivation cohort, both scores outperformed SAVE (oAUC = 0.568) and SOFA (oAUC = 0.699) scores. A LACT‐8 ≥ 3 had a specificity for mortality of 97.9% and 92.9%, in the derivation and validation cohorts, respectively.
Conclusions
The LACT‐8 score can predict inpatient mortality prior to before cannulation for VA‐ECLS. LACT‐8 can be implemented utilizing clinical data without the need for an online calculator.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35114052</pmid><doi>10.1002/ccd.30106</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9962-8855</orcidid></addata></record> |
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| identifier | ISSN: 1522-1946 |
| ispartof | Catheterization and cardiovascular interventions, 2022-03, Vol.99 (4), p.1115-1124 |
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| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Cannulation cardiogenic shock Catheterization Coma Extracorporeal membrane oxygenation Hemoglobin Hospital Mortality Humans Lactic Acid mechanical circulatory support Morbidity Mortality outcome Patients Retrospective Studies Shock, Cardiogenic - diagnosis Shock, Cardiogenic - therapy Treatment Outcome |
| title | Predicting mortality in nonsurgical patients before cannulation for veno‐arterial extracorporeal life support: Development and validation of the LACT‐8 score |
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