Predicting mortality in nonsurgical patients before cannulation for veno-arterial extracorporeal life support: Development and validation of the LACT-8 score

Dustin Hillerson, Hoyle L. Whiteside, Adam J. Dugan, Riley D. Coots, Thomas A. Tribble, Ahmed Abdel-Latif, Gbolahan O. Ogunbayo, Meredith S. Duncan, Vedant A. Gupta

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We sought to derive and validate a model to predict inpatient mortality after veno-arterial extracorporeal life support (VA-ECLS) based on readily available, precannulation clinical data. Background: Refractory cardiogenic shock supported by VA-ECLS is associated with high morbidity and mortality. Methods: VA-ECLS cases at our institution from January 2014 through July 2019 were retrospectively reviewed. Exclusion criteria were cannulation: (1) at another institution; (2) for primary surgical indication; or (3) for extracorporeal cardiopulmonary resuscitation. Multivariable logistic regression compared those with and without inpatient mortality. Multiple imputation was performed and optimism-adjusted area under the curve (oAUC) values were computed. Results: VA-ECLS cases from August 2019 through November 2020 were identified as a validation cohort. In the derivation cohort (n = 135), the final model included Lactate (mmol/L), hemoglobin (g/dl; Anemia), Coma (Glasgow Coma Scale [GCS] < 8) and resusciTATEd cardiac arrest (LACTATE score; oAUC = 0.760). In the validation cohort (n = 30, LACTATE showed similar predictability [AUC = 0.710]). A simplified (LACT-8) score was derived by dichotomizing lactate (>8) and hemoglobin (<8) and summing together the number of components for each patient. LACT-8 performed similarly (derivation, oAUC = 0.724; validation, AUC = 0.725). In the derivation cohort, both scores outperformed SAVE (oAUC = 0.568) and SOFA (oAUC = 0.699) scores. A LACT-8 ≥ 3 had a specificity for mortality of 97.9% and 92.9%, in the derivation and validation cohorts, respectively. Conclusions: The LACT-8 score can predict inpatient mortality prior to before cannulation for VA-ECLS. LACT-8 can be implemented utilizing clinical data without the need for an online calculator.

Original languageEnglish
Pages (from-to)1115-1124
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume99
Issue number4
DOIs
StatePublished - Mar 1 2022

Bibliographical note

Funding Information:
We thank the Center for Clinical and Translational Science of the University of Kentucky for assistance in data extraction. This study is supported by the National Institutes of Health, National Center for Advancing Translational Sciences through grant number UL1TR001998. Dr. Abdel‐Latif is supported by the NIH Grant R01 HL124266. Drs. Dugan and Duncan are supported by the University of Kentucky Cardiovascular Research Priority Area. The content is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors. The sponsors did not influence the study design, the collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.

Publisher Copyright:
© 2022 Wiley Periodicals LLC.

Keywords

  • cardiogenic shock
  • mechanical circulatory support
  • outcome

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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