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High Serum Bilirubin Levels, NT-pro-BNP, and Lactate Predict Mortality in Long-Term, Severely Ill Respiratory ECMO Patients

Kaestner, Franziska*; Rapp, Daniel; Trudzinski, Franziska C.*; Olewczynska, Nicole*; Wagenpfeil, Stefan; Langer, Frank; Flaig, Monika*; Wilkens, Heinrike*; Bals, Robert*; Klingele, Matthias§; Lensch, Christian*; Fähndrich, Sebastian*; Lepper, Philipp M.*

doi: 10.1097/MAT.0000000000000610
Clinical Critical Care

Mortality in patients treated with extracorporeal membrane oxygenation (ECMO) is high. Therefore, it is crucial to better understand conditions that are associated with mortality in ECMO patients. In this retrospective analysis, we observed 51 patients treated with high-flow ECMO in 2013 and 2014 at our center. We recorded laboratory values and intensive care procedures. The hypothesis of bilirubin being a predictor of mortality during ECMO treatment was initially addressed. Therefore, laboratory values were obtained before initiation and at the time of highest bilirubin throughout the procedure. Receiver operating characteristic (ROC) curves and survival analysis were conducted. Our cohort consisted of patients with advanced age (median: 55 years; range: 22–76) and high mortality (26/51; 51%). Lactate, bilirubin, and NT-pro-BNP were significantly (p < 0.05) associated with mortality in univariable analyses. The cut-off values with highest Youden’s index were bilirubin ≥10 mg/dl, lactate ≥2.25 mmol/L, and NT-pro-BNP ≥11,500 pg/ml. A multivariable analysis, revealed an area under the curve (AUC) of 0.85 (95% confidence interval [CI]: 0.74–0.97), sensitivity of 0.79, and specificity of 0.91. Bilirubin, lactate, and NT-pro-BNP were associated with mortality during ECMO treatment. However, laboratory values were only evaluated at the time of peak bilirubin.

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From the *Department of Internal Medicine V, University Hospital of Saarland, D-66421 Homburg, Germany; Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany; Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, D-66421 Homburg, Germany; and §Department of Internal Medicine IV, University Hospital of Saarland, D-66421 Homburg, Germany.

Submitted for consideration December 2016; accepted for publication in revised form May 2017.

Current address: Franziska Kaestner, Schlossergasse 56/1, 89077 Ulm, Germany.

Disclosure: F.K. and F.T. received travelling fees from Maquet; D.R., N.O., S.W., F.L., M.F., H.W., R.B., C.L., and S.F. have nothing to disclose; M.K. received speaker fees from Baxter, Fresenius Medicale Care, CytoSorbents, and Mitsubishi; P.L. received travelling fees from Maquet and speaker fees from Novalung, Mitsubishi Pharma, Maquet, and CSL Behring.

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Correspondence: Philipp M. Lepper, Department of Internal Medicine V, Pneumology and Critical Care Medicine, University Hospital of Saarland, Kirrberger Street 1, 66421 Homburg/Saar, Germany. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs