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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOMINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596

 

Minerva Anestesiologica 2016 Nov 18

Altered liver function in patients undergoing veno-arterial extracorporeal membrane oxygenation (ECMO) therapy

Aaron BLANDINO ORTIZ 1, Irene LAMANNA 1, Elio ANTONUCCI 1, Selene POZZEBON 1, Antonio M. DELL’ANNA 1, Jean L. VINCENT 1, Daniel DE BACKER 1, 2, Fabio S. TACCONE 1

1 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium; 2 Department of Intensive Care and Emergency CHIREC, Hopital de Braine, Braine-l'Alleud, Belgium

BACKGROUND: Multiple organ dysfunction can occur in patients undergoing Veno-arterial Extra Corporal Membrane Oxygenation (VA-ECMO); however, liver function has not been well studied in this setting.
METHODS: In a review of our institutional ECMO database (n=162), we collected aspartate (AST) and alanine (ALT) transaminases, total bilirubin and international normalized ratio (INR) at time of ECMO initiation (baseline) and once daily during therapy in patients who survived for at least 24 hours. Elevated liver enzymes (ELE) were defined if AST and/or ALT were > 200 UI/L, and acute liver failure (ALF) as the presence of an INR ≥ 1.5, new onset encephalopathy and an elevated total bilirubin concentrations.
RESULTS: On a total of 80 patients undergoing VA-ECMO, 69 patients met the inclusion criteria (cardiogenic shock, n=52; refractory cardiac arrest, n=15; cardiac failure following severe ARDS, n=2). Of them, 45 (65%) had early ELE after ECMO initiation (median highest AST and ALT were 528 [251-2606] UI/L and 513 [130-1031] UI/L, respectively). Two thirds of patients with ELE (N = 30) had a progressive reduction in AST and ALT, but the levels were normalized only after 5 [5-6] days. Among patients with ELE, 21/45 (47%) had AST and/or ALT levels above > 1000 UI/L. A total of 14/69 (20%) patients developed ALF. However, mortality rate was not significantly higher in patients with ELE or ALF when compared to others.
CONCLUSIONS: A substantial proportion of patients needing VA-ECMO have early ELE, which usually improves over days. The prognostic implications are not evident.

lingua: Inglese


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