title: Prognosis of patients on extracorporeal membrane oxygenation: the impact of acute kidney injury on mortality.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, such as those with life-threatening respiratory failure or postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients treated with ECMO and identified the relationship between prognosis and the Acute Kidney Injury Network (AKIN) scores obtained at pre-ECMO support (AKIN0-hour); and at post-ECMO support 24 hours (AKIN24-hour) and 48 hours (AKIN48-hour).
  
  
  METHODS
  This study reviewed the medical records of 102 critically ill patients on ECMO support at a specialized intensive care unit at a tertiary care university hospital between March 2002 and January 2008. Demographic, clinical, and laboratory variables were retrospectively collected as survival predicators.
  
  
  RESULTS
  The overall mortality rate was 57.8%. The most common condition requiring ECMO support was cardiogenic shock. Goodness-of-fit was good for AKIN0-hour, AKIN24-hour, and AKIN48-hour criteria. The AKIN0-hour, AKIN24-hour, and AKIN48-hour scoring systems also had excellent areas under the receiver operating characteristic curve (0.804±0.046, 0.811±0.045, and 0.858±0.040, respectively). Furthermore, multiple logistic regression analysis indicated that AKIN48-hour, age, and Glasgow Coma Scale score on the first day of intensive care unit admission were independent risk factors for hospital mortality. Finally, cumulative survival rates at 6-month follow-up after hospital discharge differed significantly (p<0.05) for AKIN48-hour stage 0 versus AKIN48-hour stages 1, 2, and 3; and AKIN48-hour stage 1 and 2 versus AKIN48-hour stage 3.
  
  
  CONCLUSIONS
  During ECMO support, the AKIN48-hour scoring system proved to be a reproducible evaluation tool with excellent prognostic abilities for these patients.
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan. cyc2356@adm.cgmh.org.tw
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Chan-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Jenq
authors.forename: Kuo-Chang
authors.initials: KC
authors.lastname: Juan
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D000328:Adult; D015331:Cohort Studies; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate