Key result
Elevated NLR within 24 hours of VA-ECMO is linked to ~232% higher in-hospital mortality.
Why the study?
Mortality remains high during VA-ECMO, but early assessment of prognosis is challenging and valid markers are lacking.
Do early measurements of NLR, PLR, and PCT predict in-hospital mortality in patients undergoing VA-ECMO for cardiogenic shock?
Cohort (n=92)
No
Do early measurements of NLR, PLR, and PCT predict in-hospital mortality in patients undergoing VA-ECMO for cardiogenic shock?
Early measurement of NLR is independently associated with in-hospital mortality in patients on VA-ECMO for cardiogenic shock, though its discriminative ability is weak, while PLR and PCT are not useful.
Answers are grounded in this paper and cite their sources.
May support early risk stratification in VA-ECMO; hypothesis-generating and requires prospective validation before clinical use.
The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasing, but mortality remains high. Early assessment of prognosis is challenging and valid markers are lacking. This study aimed to investigate Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte-Ratio (PLR) and Procalcitonin (PCT) for early assessment of prognosis in patients undergoing VA-ECMO. This retrospective single-center cohort study included 344 consecutive patients ≥ 18 years who underwent VA-ECMO due to cardiogenic shock. Main exposures were NLR, PLR and PCT measured within 24 h after VA-ECMO initiation. The primary endpoint was all-cause in-hospital mortality. In total, 92 patients were included into final analysis (71.7% male, age 57 ± 14 years). In-hospital mortality rate was 48.9%. Receiver operating characteristics (ROC) curve revealed an area under the curve (AUC) of 0.65 [95% confidence interval (CI) 0.53-0.76] for NLR. The AUCs of PLR and PCT were 0.47 [95%CI 0.35-0.59] and 0.54 [95%CI 0.42-0.66], respectively. Binary logistic regression showed an adjusted odds ratio of 3.32 [95%CI 1.13-9.76] for NLR, 1.0 [95%CI 0.998-1.002] for PLR and 1.02 [95%CI 0.99-1.05] for PCT. NLR is independently associated with in-hospital mortality in patients undergoing VA-ECMO. However, discriminative ability is weak. PLR and PCT seem not to be suitable for this purpose.
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Roth et al. (2022) conducted a cohort in Refractory cardiogenic shock requiring VA-ECMO (n=92). Neutrophil-Lymphocyte Ratio (NLR) was evaluated on All-cause in-hospital mortality (OR 3.32, 95% CI 1.13-9.76, p=0.029). Elevated Neutrophil-Lymphocyte Ratio (cutoff 13) measured within 24 hours of VA-ECMO initiation was independently associated with increased in-hospital mortality (adjusted OR 3.32).
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