Nomogram to predict survival outcome of patients with veno-arterial extracorporeal membrane oxygenation after refractory cardiogenic shock

ABSTRACT

Objective

: This study aims to develop a nomogram model to predict the survival of refractory cardiogenic shock (RCS) patients that received veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Methods

A total of 235 and 209 RCS patients were supported with VA-ECMO from January 2018 to December 2019 in Guangdong Provincial People’s Hospital, and from January 2020 to December 2020 in four third-grade and class-A hospitals were a development cohort (DC) and validation cohort (VC), respectively. Finally, 137 and 98 patients were included in the DC and VC. Multivariate logistic regression analysis was used to identify variables, and only these independent risk factors were used to establish the nomogram model. The receiver operating characteristic curve (ROC), calibration plot, decision curve, and clinical impact curves were used to evaluate the nomogram’s discriminative ability, predictive accuracy, and clinical application value.

Results

Pre-ECMO cardiogenic arrest (pre-ECA), lactate (Lac), inotropic score (IS), and modified nutrition risk in the critically ill score (mNUTRIC score) were incorporated into the nomogram. This showed good discrimination in the DC, with an area under ROC (AUROC) and a 95% confidence interval (CI) of 0.959 (0.911–0.986). The AUROC (95% CI) of the VC was 0.928 (0.858–0.971). The calibration plots of the DC and VC presented good calibration results. The decision curve and clinical impact curve of the nomogram provided improved benefits for RCS patients.

Conclusions

This study established a prediction nomogram composed of pre-ECA, Lac, IS, and mNUTRIC scores that could help clinicians to predict the survival probability at hospital discharge precisely and rapidly for RCS patients that received VA-ECMO.

KEYWORDS:

• Veno-arterial extracorporeal membrane oxygenation
• nomogram
• refractory cardiogenic shock

Supplementary material

Supplemental data for this article can be accessed here.

Declaration of Financial/Other Relationships

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Authors’ contributions

Yiyu Deng designed the study. Binfei Li, Zhou Cheng, Zeng Wang, Xiangwei Huang, Minghai Xian, Jian Zhuang, and Jimei Chen provided the data. Huifang Wang participated in the data entry. Huifang Wang was responsible for the data analysis. Huifang Wang wrote the draft. Chunbo Chen, Chengbin Zhou, and Yiyu Deng critically revised the manuscript. All authors have read and approved the final version of the manuscript to be published.

Availability of data and material

The datasets used or analyzed during this study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The demographic, physiological and hospital-outcome data were obtained from Electronic Medical Records (EMR). This retrospective study did not modify the existing diagnostic or therapeutic strategies. This study was approved by the Ethics Committee of Guangdong Provincial People’s Hospital (No. gdrec2019775H) and granted this study exemption from informed consent due to its retrospective nature.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (82072230) the National Natural Science Foundation of Guangdong, China (2019A1515010206), Science and Technology Program of Guangzhou, China (grant no. 202002030094), Outstanding Young Medical Talents in Guangdong Province (KJ012019435), High-level Hospital Construction Project of Guangdong Provincial People’s Hospital (DFJH2020020), and the Guangdong Project of Science and Technology (2020A111128030, 2017A070701013 and 2017B090904034).