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J Chest Surg

Published online April 25, 2023

Copyright © Journal of Chest Surgery.

Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock

Jae Beom Jeon, M.D. 1, Cho Hee Lee, M.D. 1, Yongwhan Lim, M.D., Ph.D. 2, Min-Chul Kim, M.D., Ph.D. 2, Hwa Jin Cho, M.D., Ph.D. 3, Do Wan Kim, M.D. 1, Kyo Seon Lee, M.D. 1, In Seok Jeong, M.D., Ph.D. 1

Departments of 1Thoracic and Cardiovascular Surgery and 2Cardiology, Chonnam National University Hospital, Chonnam National University Medical School; 3Department of Pediatrics, Chonnam National University Children’s Hospital, Chonnam National University Medical School, Gwangju, Korea

Correspondence to:In Seok Jeong
Tel 82-62-220-6546
Fax 82-62-227-1636
E-mail isjeong1201@gmail.com;
isjeong1201@jnu.ac.kr
ORCID
https://orcid.org/0000-0002-2249-0667

Received: October 26, 2022; Revised: January 29, 2023; Accepted: January 31, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO.
Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared.
Results: Patients’ mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11–0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63–0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001).
Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.

Keywords: Albumin, Extracorporeal membrane oxygenation, Cardiogenic shock

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J Chest Surg

Published online April 25, 2023

Copyright © Journal of Chest Surgery.

Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock

Jae Beom Jeon, M.D. 1, Cho Hee Lee, M.D. 1, Yongwhan Lim, M.D., Ph.D. 2, Min-Chul Kim, M.D., Ph.D. 2, Hwa Jin Cho, M.D., Ph.D. 3, Do Wan Kim, M.D. 1, Kyo Seon Lee, M.D. 1, In Seok Jeong, M.D., Ph.D. 1

Departments of 1Thoracic and Cardiovascular Surgery and 2Cardiology, Chonnam National University Hospital, Chonnam National University Medical School; 3Department of Pediatrics, Chonnam National University Children’s Hospital, Chonnam National University Medical School, Gwangju, Korea

Correspondence to:In Seok Jeong
Tel 82-62-220-6546
Fax 82-62-227-1636
E-mail isjeong1201@gmail.com;
isjeong1201@jnu.ac.kr
ORCID
https://orcid.org/0000-0002-2249-0667

Received: October 26, 2022; Revised: January 29, 2023; Accepted: January 31, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO.
Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared.
Results: Patients’ mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11–0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63–0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001).
Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.

Keywords: Albumin, Extracorporeal membrane oxygenation, Cardiogenic shock

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