Cardiac surgery score (CASUS) improves outcome prediction in patients treated with extracorporal life support (ECLS).

Abstract

The often-unexpected necessity of extracorporeal life support (ECLS) implies that information on patients and end-organ functions at time of implantation is scarce. However, there is a need for early prognostic indicators and a score predicting the outcome. Therefore, we evaluated established laboratory parameters and widely used intensive care scores - cardiac surgery score (CASUS) and sequential organ failure assessment (SOFA) after ECLS implantation. In this retrospective analysis, 90 consecutive adult patients with veno-arterial ECLS were included. Baseline demographic data, laboratory markers, CASUS and SOFA were acquired 12 h after ECLS implantation. A total of 61 patients (67.8%) could be weaned from ECLS and 48 patients (53.3%) were discharged from hospital. Four patients were switched to a left ventricular assist device. The outcome did not depend on indication for ECLS. Furthermore, multivariable regression analysis identified lactate (OR=1.08; 95%CI: 1.01-1.26; p=0.03) and urine output (OR=0.99; 95%CI: 0.986-0.998; p=0.01) as independent predictors of in-hospital mortality. Evaluating intensive care scores, CASUS (AUROC=0.68; 95%CI: 0.57-0.77; p=0.002) had a higher prognostic relevance in comparison with SOFA (AUROC=0.58; 95%CI: 0.47-0.69; p=0.187). Our data indicate that lactate and urine output are early independent predictors for in-hospital mortality of ECLS patients. The CASUS proved to be a satisfactory evaluation tool with good prognostic abilities in these special patients.