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Performance of Multiple Risk Assessment Tools to Predict Mortality for Adult Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation Therapy： An External Validation Study Based on Chinese Single-center Data

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Chinese Medical Journal 2016年第14期129卷 1688-1695页

作者： Lei Huang Tong Li Lei Xu Xiao-Min Hu Da-Wei Duan Zhi-Bo Li Xin-Jing Gao Jun Li Peng Wu Ying-Wu Liu Song Wang Yu-Heng Lang Department of Heart Center Tianiin Third Central Hospital TianLin 300170 China Depariment of Intensive Care Unit l:ianjin Third Central Hospital Tianjin 300170 China

Background： There has been no external validation of survival prediction models for severe adult respiratory distress syndrome （ARDS） with extracorporeal membrane oxygenation （ECMO） therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data. Methods： A retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE （Predicting death for severe ARDS on VV-ECMO）, ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction （RESP） score, a center-specific model developed lbr inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation （APACHE） II and Sequential Organ Failure Assessment （SOFA） were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve （AUC）. Results： The RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 （95% confidence interval [CI], 0.659-1 .010, P = 0.007） and 0.762 （95% CI, 0.558-0.965, P = 0.035）, respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 （95% CI, 0.571-1.009, P = 0.038）. However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since Conclusions： The RESP, APCHAE 11, and SOFA scorings only one patient died six months postdischarge. systems show good predictive value for intra-hospital

关键词： Acute Respiratory Distress Syndrome Acute Respiratory Failure Extracorporeal Membrane Oxygenation predictivemodel Survival Outcome

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