SPC365

Prediction of in-hospital mortality in patients admitted for cardiogenic shock treated with VA-ECMO – validation of SAVE score and the incremental value of serum lactate

Session: Comunicações Orais - Sessão 04 - Choque cardiogénico
Speaker: João Presume

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Comunicações Orais
FP Number: ---
Authors: João Presume; Daniel Gomes; Francisco Albuquerque; Pedro Lopes; Ana Rita Bello; Catarina Brízido; Christopher Strong; Jorge Ferreira; Miguel Mendes; José Pedro Neves; Helena Brandão; António Tralhão

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option to provide circulatory and pulmonary support to patients with cardiogenic shock. However, a risk profile assessment is essential for an adequate selection of patients for this type of therapy.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The aim of this study was to 1) validate the SAVE score in a Portuguese cohort of patients treated with VA-ECMO due to cardiogenic shock; 2) evaluate the prognostic impact of the maximum serum lactate level pre-VA-ECMO implantation; 3) assess the ability of lactate to improve risk stratification by the SAVE score. </span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">We conducted a single-center retrospective analysis of patients treated with VA-ECMO due to cardiogenic shock from 2017 until 2022. Variable assessments were considered before VA-ECMO implantation. The primary outcome analyzed was in-hospital mortality. </span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A total of 61 patients were included (52&plusmn;12 years, 74% male, 40% with acute myocardial infarction, 54% with an ejection fraction &lt;20%, and 74% in SCAI stage D pre-implantation). Overall, 38 (62%) died during hospitalization. The mean SAVE score was -1.7&plusmn;7.2 points, and the median maximum serum lactate before ECMO implantation was 5.8 [2.7; 11.8] mmol/L. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">SAVE score showed a statistically significant association (1&plusmn;5 vs. -4&plusmn;7; OR 0.872 [0.789; 0.964] per each point increase; p=0.008) and good discriminative power (AUC 0.710; p=0.006) to predict in-hospital mortality. When grouping patients according to this score, 25 (41%) were classified as SAVE risk class I or II, and 36 (59%) as SAVE class III, IV, or V. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Maximum serum lactate before VA-ECMO implantation also showed a significant association (4.5&plusmn;3.1 vs. 9.6&plusmn;6.6; OR 1.264 [1.066;1.498] per each 1mmol/l increase; p=0.007) and good discriminative power (AUC 0.771; p=0.001) to predict the primary outcome. The best lactate cut-off to identify high mortality risk was 5 mmol/l with a sensitivity of 74% and a specificity of 76%. Additionally, taking into account this threshold, lactate significantly enhanced the SAVE score group stratification, with a net reclassification improvement of 36.7% (p=0.021).</span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In this cohort of patients, the SAVE score was significantly associated with in-hospital mortality. Maximum serum lactate before VA-ECMO implantation was a strong predictor of in-hospital mortality and significantly improved SAVE score risk stratification. </span></span></p>