title: Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery.
abstract: 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, despite significant advances in ECMO techniques and management, prognosis remains poor and accurate risk stratification challenging. We therefore evaluated the predictive value of liver function variables on all-cause mortality in patients undergoing venoarterial ECMO support after cardiovascular surgery.
  
  
  METHODS
  We included into our single-center registry a total of 240 patients undergoing venoarterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center.
  
  
  RESULTS
  The median follow-up was 37 months (interquartile range 19-67 months), and a total of 156 patients (65%) died. Alkaline phosphatase and total bilirubin were the strongest predictors for 30-day mortality, with adjusted hazard ratios (HRs) per 1-standard deviation increase of 1.36 (95% confidence interval [CI] 1.10-1.68; P = 0.004) and 1.22 (95% CI 1.07-1.40; P = 0.004), respectively. The observed associations persisted for long-term mortality, with adjusted HRs of 1.27 (95% CI 1.03-1.56; P = 0.023) for alkaline phosphatase and 1.22 (95% CI 1.07-1.39; P = 0.003) for total bilirubin.
  
  
  CONCLUSIONS
  The present study demonstrates that elevated values of alkaline phosphatase and total bilirubin are sensitive parameters for predicting the short-term and long-term outcomes of ECMO patients.
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Roth
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Lore
authors.initials: L
authors.lastname: Schrutka
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Binder
authors.affiliation: University Clinic of Orthopedics, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Kriechbaumer
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems an der Donau, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Koinig
authors.affiliation: Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Steinlechner
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria. klaus.distelmaier@meduniwien.ac.at.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000032:analysis / Q000097:blood; D001663:Bilirubin / Q000032:analysis / Q000097:blood; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000209:etiology; D016019:Survival Analysis; D013557:Switzerland
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: Alkaline phosphatase; Bilirubin; Cardiovascular surgery; Extracorporeal membrane oxygenation; Liver function; Mortality; Outcome