Liver Dysfunction Associated With In-Hospital Mortality in Adult Extracorporeal Membrane Oxygenation Support

Abstract

Extracorporeal membrane oxygenator support is a powerful clinical tool that is currently enjoying a resurgence in popularity. Wider use of extracorporeal membrane oxygenator support is limited by its significant risk profile and extreme consumption of resources. This study examines the role of markers of liver dysfunction in predicting outcomes of adult patients requiring extracorporeal membrane oxygenator support.

Design: Retrospective review.

Setting: Large extracorporeal membrane oxygenator center, Chicago, IL.

Patients: This study reports a single institution experience examining all adult patients for whom extracorporeal membrane oxygenator support was used over an 8-year period. Data were collected regarding patient demographics, details of extracorporeal membrane oxygenator support provided, laboratory data, and outcomes. Trends in liver function were examined for their ability to predict survival.

Intervention: Extracorporeal membrane oxygenator support, critical care.

Measurements and main results: Mean age was 50 years (range, 19-82 yr). There were 86 male patients (56.6%) and 66 female patients (43.4%). Indications for initiation of extracorporeal membrane oxygenator support included cardiac 76 patients (50.0%), respiratory 48 patients (31.6%), extracorporeal cardiopulmonary resuscitation 21 patients (13.3%), and combined cardiac/respiratory seven patients (4.6%). Mean duration of extracorporeal membrane oxygenator support was 17 days (range 1-223 d) or median 8 days (interquartile range, 4-17 d). Overall, in-hospital mortality was 56% (86/152). Forty-five percent of adult patients (68/152) surpassed at least one of the following established liver dysfunction thresholds: total bilirubin greater than 15 mg/dL, aspartate aminotransferase greater than 20× upper limit of normal, and alanine aminotransferase greater than 20× upper limit of normal. The multivariable logistic analysis yielded three significant findings associated with in-hospital mortality: highest total bilirubin greater than 15 (adjusted odds ratio = 4.40; 95% CI, 1.19-21.87; p = 0.04), age (adjusted odds ratio = 1.03; 95% CI, 1.00-1.05; p = 0.04), and highest lactate (adjusted odds ratio = 1.15; 95% CI, 1.06-1.26; p = 0.002).

Conclusions: Increases in age, highest total bilirubin, and lactate all correlated with in-hospital mortality in multivariable analysis of patients requiring extracorporeal membrane oxygenator support.

Keywords: extracorporeal membrane oxygenator; liver dysfunction; mortality; outcomes.

Figure 1.

Multivariable logistic regression model for in-hospital mortality. Odds ratios (ORs) have been log transformed. ^*Indicates statistical significance. ALP = alkaline phosphatase, ALT = alanine aminotransferase, AST = aspartate aminotransferase, INR = international normalized ratio.