Short-term Prognostic Value of Early Fluid Balance and Lactate Clearance in Patients with Acute Myocardial Infarction Combined with Cardiogenic Shock Treated with Extracorporeal Membrane Oxygenation

Abstract

Background Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) , and it is important to explore the efficacy of extracorporeal membrane oxygenation (ECMO) in AMI patients combined with CS.Objective To investigate the short-term prognostic value of early fluid balance and lactate clearance in AMI patients combined with CS treated with ECMO.Methods The clinical data of 49 hospitalized AMI patients combined with CS treated with ECMO from April 2017 to December 2022 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The included patients were divided into the survival group (n=27) and death group (n=22) according to 30-day post-ECMO outcomes. Univariate and Multivariable Logistic regression analyses were used to evaluate the influencing factors of 30-day post-ECMO death. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of 24-h fluid balance, 24-h lactate clearance and their combination for 30-day post-ECMO outcomes. Delong test was used to compare the area under the ROC curve (AUC) .Results Age, creatinine level, the proportion of offender vessel as left main or left anterior descending branch, acute kidney injury and continuous renal replacement therapy, 24-h fluid balance, 24-h lactate with ECMO in the death group were higher than the survival group, and 24-h lactate clearance was lower than the survival group (P<0.05) . Multivariate Logistic regression analysis showed that age〔OR=1.102, 95%CI (1.008, 1.205) 〕, acute kidney injury〔OR=15.888, 95%CI (1.299, 194.388) 〕, 24-h fluid balance〔OR=1.085, 95%CI (1.003, 1.174) 〕and 24-h lactate clearance〔OR=0.001, 95%CI (0, 0.096) 〕were independent influencing factors of 30-d post-ECMO outcomes in AMI patients combined with CS. The ROC analysis showed that the AUCs for 24-h fluid balance, 24-h lactate clearance and their combination in the prediction of 30-d post-ECMO outcomes in AMI patients combined with CS were 0.688〔95%CI (0.539, 0.812) , P=0.015〕, 0.707〔95%CI (0.560, 0.828) , P=0.006〕, 0.847〔95%CI (0.715, 0.934) , P<0.001〕, respectively. The AUC of their combination was higher than 24-h fluid balance (Z=2.05, P<0.05) and 24-h lactate clearance (Z=2.30, P<0.05) , respectively.Conclusion Both 24-h fluid balance and 24-h lactate clearance were associated with 30-d post-ECMO outcomes, and their combination was more effective in predicting 30-d post-ECMO death.

Keywords

• myocardial infarction|st elevation myocardial infarction|shock, cardiogenic|extracorporeal membrane oxygenation|fluid balance|lactate clearance|root cause analysis