Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID-19.

Autor: Huespe IA; Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.; Área de investigación en medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.; Universidad de Buenos Aires, Buenos Aires, Argentina.; Global Clinical Scholars Research Trainee, Harvard Medical School, Boston, Massachusetts, USA., Lockhart C; Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Kashyap R; Global Clinical Scholars Research Trainee, Harvard Medical School, Boston, Massachusetts, USA.; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.; Department of Research, WellSpan Health, York, Pennsylvania, USA., Palizas F Jr; Unidad de Terapia Intensiva Adultos, Clínica Bazterrica, Buenos Aires, Argentina., Colombo M; Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina., Romero MDP; Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina., Prado E; Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Casabella García CA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA., Las Heras M; Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Carboni Bisso I; Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2023 Jun; Vol. 47 (6), pp. 1007-1017. Date of Electronic Publication: 2023 Jan 12.
DOI: 10.1111/aor.14493
Abstrakt: Background: The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021.
Materials and Methods: We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure.
Results: We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67-0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10.
Conclusion: The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.
(© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
Databáze: MEDLINE
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