https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 2Universitätsklinikum Regensburg Herz-, Thorax- und herznahe Gefäßchirurgie Regensburg, Deutschland; 3Universitätsklinikum Regensburg Regensburg, Deutschland
Background:
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an advanced therapy in patients with severe cardiogenic shock. Secondary organ failures are seen regularly in V-A ECMO and acute kidney injury (AKI) is one of the most frequent secondary organ failures during V-A ECMO. Urinary NT-proBNP has already shown promising results as a predictor in patients with chronic heart failure.
Aim:
The goal of his study was to examine the prognostic value of urinary NT-proBNP levels regarding the of AKI with the necessity for renal replacement therapy (RRT) in patients with V-A ECMO.
Methods:
The current study is a prospective observational study in the university hospital Regensburg in patients with V-A ECMO from 30.08.2022 to 11.09.2024. Urinary NT-proBNP levels were measured after ECMO initiation. Initially anuric patients were excluded from this analysis.
Results:
90 patients with VA-ECMO were included in the analysis (mean 57 years old, 63% male). 69 Patients (77%) suffered from AKI during ECMO therapy, 22 of those (24%) received RRT. ECMO-therapy lasted in mean 5 days. Patients suffering from AKI with the necessity for RRT showed significantly higher levels of urinary NT-proBNP compared to patients with AKI without RRT and those without AKI during ECMO therapy (12100 ng/l vs 1200 ng/l vs 100 ng/l, each p= 0.001). In ROC analysis urinary NT-proBNP showed promising value as a predictor for AKI (AUC 0.74, sensitivity 42%, specificity 85% for 6836 ng/l) as well as AKI with the necessity for RRT (AUC 0.71, sensitivity 46% specificity 95% for 26673 ng/l). In binary logarithmic regression the logarithm of urinary NT-proBNP was shown as an independent and statistically significant predictor for the occurrence of AKI (HR 2.32, 1.31-4.12, p=0.004 ), opposite to age, sex, the duration of ECMO therapy and the preexisting degree of renal function (each p=n.s.). For necessity for RRT due to AKI, the logarithm of urinary NT-proBNP and the duration of ECMO therapy were revealed as independent and statistically significant predictors (HR 1.81, 1.11-2.94, p=0.016 for urinary NT-proBNP; HR 1.13, 1.03-1.23, p=0.012 for ECMO duration).
Conclusion:
Patients with V-A ECMO suffer in many cases from secondary organ failure. Urinary NT-proBNP showed promising results as an independent predictor for AKI as well as AKI with the necessity for RRT.