Ass.Prof. Priv.Doz. Dr. Georg Goliasch, PhD
MedUni Vienna RESEARCHER OF THE MONTH, March 2017
Background. Extracorporeal membrane oxygenation (ECMO) represents a valuable and rapidly evolving therapeutic option in patients with severe heart or lung failure following cardiovascular surgery. However, survival remains poor and accurate risk stratification challenging. We therefore evaluated the predictive value of urinary output (UO) within 24-hours after ECMO initiation on mortality in patients undergoing veno-arterial ECMO support following cardiovascular surgery and aimed to improve established risk prediction models
Methods and Results. We included 205 patients undergoing veno-arterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center into our single-centre registry. During a median follow-up time of 35 months (IQR 19- 69), 64% of patients died. 24-hour UO was the strongest predictor of outcome among renal function parameters with an ajdusted HR per 1-SD of 0.55 (95%CI 0.40- 0.76; P<0.001) for 30-day mortality and of 0.65 (95%CI 0.53- 0.86; P=0.002) for 2-year long-term mortality. Most remarkably, 24-hour UO showed additional prognostic value beyond that achievable with the SAPS-3 and SOFA score indicated by improvements in the category-free net reclassification index for 30-day mortality (SAPS-3: 36%; P=0.015; SOFA: 36%; P=0.02) as well as for 2-year mortality (SAPS-3: 33%; P=0.02; SOFA: 43%; P=0.005).
Conclusions. We identified 24-hour UO as a strong and easily available predictor of mortality in patients undergoing ECMO therapy following cardiovascular surgery. Implementation of 24-hour UO leads to a substantial improvement of established risk prediction models in this vulnerable patient population. These results are particularly compelling, because measurement of UO is inexpensive and routinely performed in all critical care units.
-  Distelmaier K, Roth C, Schrutka L, Binder C, Schreiber C, Hoffelner F, Heinz G, Lang IM, Maurer G, Koinig H, Steinlechner B, Niessner A, Goliasch G. Urinary output predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery. Crit Care Med. 2016 Mar 11;20:57.
-  Goliasch G, Goscinska-Bis K, Caracciolo G, Nakabo A, Smolka G, Pedrizzetti G, Narula J, Sengupta PP. CRT improves LV filling dynamics: Insights from echocardiographic particle imaging velocimetry. JACC Cardiovasc Imaging. 2013 Jun;6(6):704-13.
-  Goliasch G, Kleber M, Richter B, Plischke M, Hoke M, Haschemi A, Marculescu R, Endler G, Grammer T, Pilz S, Tomaschitz A, Silbernagel G, Maurer G, Wagner O, Huber K, Mannhalter C, Niessner A. Routinely available biomarkers improve prediction of long-term mortality in stable coronary artery disease: the Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) risk score. Eur Heart J. 2012 Sep;33(18):2282-9
-  Kleber ME*, Goliasch G*, Grammer TB, Pilz S, Tomaschitz A, Silbernagel G, Maurer G, März W, Niessner A. Evolving biomarkers improve prediction of long-term mortality in patients with stable CAD – the BIO-VILCAD score. J Intern Med 2014 Aug;276(2):184-94.*equally contributed
-  Goliasch G, Pavo N, Zotter-Tufaro C, Kammerlander A, Duca F, Mascherbauer J, Bonderman D. Soluble neprilysin does not correlate with outcome in heart failure with preserved ejection fraction. Eur J Heart Fail. 2016 Jan;18(1):89-93.
-  Hoke M, Wagner O, Exner M, Koppensteiner R, Schillinger M, Minar E, Mlekusch W, Goliasch G. The impact of cellular adhesion molecules on mortality in patients with stable atherosclerosis. Thromb Haemost. 2015 May 21;114(3)
-  Goliasch G, Haschemi A, Marculescu R, Endler G, Maurer G, Wagner O, Huber K, Mannhalter C, Niessner A. Butyrylcholinesterase activity predicts long-term survival in patients with coronary artery disease. Clin Chem. 2012 Jun;58(6):1055-8
-  Goliasch G, Wiesbauer F, Katsaros KM, Kastl SP, Blessberger H, Maurer G, Schillinger M, Huber K, Wojta J, Speidl WS. Premature myocardial infarction is associated with low serum levels of Wnt-1. Atherosclerosis. 2012 May;222(1):251-6
-  Distelmaier K, Niessner A, Haider D, Lang IM, Heinz G, Maurer G, Koinig H, Steinlechner B, Goliasch G. Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery. Intensive Care Med. 2013 Aug;39(8):1444-51
-  Distelmaier K, Winter MP, Rützler K, Heinz G, Lang IM, Maurer G, Koinig H, Steinlechner B, Niessner A, Goliasch G. Serum butyrylcholinesterase predicts survival following extracorporeal membrane oxygenation after cardiovascular surgery. Crit Care. 2014 Jan 30;18(1):R24