Introduction:

Nucleated red blood cells (NRBC) are rare in the peripheral circulation of healthy individuals and their presence have been associated with mortality in adults and very low birth weight newborns, however, its value as a biomarker for mortality in infants requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has yet to be studied. We sought to determine if NRBC can serve as a biomarker for ECMO mortality and inpatient mortality in infants requiring V-A ECMO.

Methods:

A single-center retrospective chart review analyzing infants <1 year of age requiring VA ECMO due to myocardial dysfunction or post-cardiotomy between January 1, 2011 to June 30, 2020.

Results:

One hundred two patients required VA ECMO. Sixty-five patients required ECMO post-cardiotomy, 19 for perioperative deterioration, and 18 for myocardial dysfunction. Fifty-one patients (50%) died (21 died on ECMO, 30 died post-ECMO decannulation). Multivariable analysis found Age <60 days (OR 13.0, 95% CI 1.9–89.6, p = 0.009), NRBC increase by >50% post-ECMO decannulation (OR 17.1, 95% CI 3.1–95.1, p = 0.001), Single Ventricle (OR 9.0, 95% CI 1.7–47.7, p = 0.01), and lactate at ECMO decannulation (OR 3.0, 95% CI 1.3–7.1, p = 0.011) to be independently associated with inpatient mortality. ROC curves evaluating NRBC pre-ECMO decannulation as a biomarker for mortality on ECMO (AUC 0.80, 95% CI 0.68–0.92, p ⩽ 0.001) and post-ECMO decannulation (AUC 0.75, 95% CI 0.65–0.84, p ⩽ 0.001) show NRBC to be an accurate biomarker for mortality.

Conclusions:

Greater than 50% increase in NRBC post-ECMO decannulation is associated with inpatient mortality. NRBC value pre-ECMO decannulation may be a useful biomarker for mortality while on ECMO and post-decannulation.

中文翻译：

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有核红细胞作为婴儿和新生儿死亡率的生物标志物，需要静脉-动脉体外膜氧合治疗心脏病

介绍：

有核红细胞 (NRBC) 在健康个体的外周循环中很少见，它们的存在与成人和极低出生体重新生儿的死亡率有关，然而，它作为需要静脉-动脉 (VA) 婴儿死亡率的生物标志物的价值) 体外膜肺氧合 (ECMO) 尚待研究。我们试图确定 NRBC 是否可以作为需要 VA ECMO 的婴儿的 ECMO 死亡率和住院死亡率的生物标志物。

方法：

一项单中心回顾性图表回顾，分析了 2011 年 1 月 1 日至 2020 年 6 月 30 日期间因心肌功能障碍或心脏切开术后需要 VA ECMO 的 1 岁以下婴儿。

结果：

12 名患者需要 VA ECMO。65 名患者在心脏切开术后需要 ECMO，19 名患者因围手术期恶化，18 名患者因心肌功能障碍。51 名患者 (50%) 死亡（21 名死于 ECMO，30 名死于 ECMO 拔管）。多变量分析发现年龄< 60 天（OR 13.0，95% CI 1.9–89.6，p = 0.009），ECMO 拔管后 NRBC 增加 >50%（OR 17.1，95% CI 3.1–95.1，p = 0.001），单ECMO 拔管时心室（OR 9.0，95% CI 1.7–47.7，p = 0.01）和乳酸（OR 3.0，95% CI 1.3–7.1，p = 0.011）与住院死亡率独立相关。ROC 曲线评估 NRBC ECMO 前拔管作为 ECMO 死亡率的生物标志物（AUC 0.80，95% CI 0.68–0.92，p   0.001) 和 ECMO 拔管后 (AUC 0.75, 95% CI 0.65–0.84, p    0.001) 显示 NRBC 是死亡率的准确生物标志物。

结论：

ECMO 拔管后 NRBC 增加超过 50% 与住院死亡率相关。ECMO 拔管前 NRBC 值可能是 ECMO 和拔管后死亡率的有用生物标志物。