Pronostic de la thrombopenie chez les patients en choc cardiogénique sous ECMO artério-veineuse - 24/11/21
Résumé |
Background |
VA-ECMO represents, in the management of refractory cardiogenic shock, a therapeutic alternative of choice when drug therapy is not available. However, this treatment is accompanied by severe complications, such as haemorrhagic and thromboembolic events. These are related to hemostasis disorders such as thrombocytopenia. The aim of this study was to describe the incidence and impact of thrombocytopenia on mortality at 90 days in patients in cardiogenic shock managed with VA-ECMO.
Material and methods |
We conducted a retrospective, monocentric study between January 2012 and December 2014. During this period, 160 patients benefited from VA-ECMO and 77 were patients in cardiogenic shock assisted for more than 48hours and were therefore included in our study.
Results |
Overall survival at 3 months was 48.6 % (36 patients). Multivariate analysis retrieves the history of heart failure (HR=2,75, CI 95 % [1,34–5,64], p=0,0059), SAPS II score (HR=1,03, CI 95 % [1,01–1,06], p=0,0020), hyperbilirubinemia (HR=1,03, CI 95 % [1,01–1,05], p=0,0031) and Lactates peak (HR=1,10, CI 95 % [1,02–1,17], p=0,0079) as prognostic factors in pre-ECMO. For post-ECMO criteria, the multivariate analysis identified only the nadir of platelets<50G/L and with the most potent HR (HR=3,1, CI 95 % [1,61–5,95], p=0,0007). Thrombocytopenia<30 G/L is associated with 85 % mortality.
Conclusion |
This study demonstrates that thrombocytopenia <50G/L is an independent mortality factor in patients in cardiogenic shock with VA-ECMO and establishes the <30G/L threshold as associated with very high mortality.
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Vol 28 - N° 4S
P. S15 - novembre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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