Oncostatin M as a Biomarker to Predict the Outcome of V-V ECMO Supported Patients with Acute Pulmonary Failure

Abstract

Reliable biomarkers to predict the outcome of Veno-Venous (V-V) ECMO therapy have not been identified. While lactic-acid (LA) levels are useful for predicting outcomes in Veno-Arterial (V-A) ECMO for patients with cardiogenic shock, they have not been reliable in V-V ECMO for patients with acute pulmonary failure. We hypothesize that markers of inflammation may be superior to markers of perfusion deficits in such patients. We evaluated Oncostatin M (OSM), a novel biomarker for inflammation (a member of the IL-6 family) for its potential to predict outcomes in patients with acute pulmonary failure requiring V-V ECMO. Following informed consent, blood samples were collected pre-cannulation, then post-cannulation on days 1-3, and then every other day until decannulation from 29 V-V ECMO patients. Plasma OSM levels were measured by ELISA and compared with plasma LA levels in concurrently collected samples. Plasma OSM release, consistent with a highly activated inflammatory state, was detected in 18 of the 29 patients prior to V-V ECMO. Of these 18 patients, 7 expired and 11 eventually recovered. As shown in Fig. 1, the pre-decannulation OSM levels were significantly higher (Mann-Whitney U test: p=0.04) in patients who eventually expired than those who recovered (Median: 90.2% vs 49.4%). On the other hand, there was no significant difference in the LA levels (Mann-Whitney U test: p= 0.56) between those that eventually recovered and those who expired (Median: 82.7% vs 83.5%). Plasma release of OSM, a novel biomarker for inflammation, was predictive of mortality in patients with acute respiratory failure supported by V-V ECMO whereas Lactic Acid levels were not. This important finding warrants further exploration.