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Validation of extracorporeal membrane oxygenation mortality prediction and severity of illness scores in an international COVID-19 cohort

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dc.contributor.authorShah, N.
dc.contributor.authorXue, B.
dc.contributor.authorXu, Z.
dc.contributor.authorYang, H.
dc.contributor.authorMarwali, E.
dc.contributor.authorDalton, H.
dc.contributor.authorPayne, P.P.R.
dc.contributor.authorLu, C.
dc.contributor.authorSaid, A.S.
dc.contributor.authorAbdukahil, S.A.
dc.contributor.authorAbdulkadir, N.N.
dc.contributor.authorAbsil, L.
dc.contributor.authorAcker, A.
dc.contributor.authorAdrião, D.
dc.contributor.authorHssain, A.A.
dc.contributor.authorAkwani, C.
dc.contributor.authorQasim, E.A.
dc.contributor.authorAlalqam, R.
dc.contributor.authorAl-Dabbous, T.
dc.contributor.authorAlex, B.
dc.contributor.authoret al.
dc.date.issued2023
dc.description.abstractBackground: Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a lifesaving support modality for severe respiratory failure, but its resourceintensive nature led to significant controversy surrounding its use during the COVID-19 pandemic. We report the performance of several ECMO mortality prediction and severity of illness scores at discriminating survival in a large COVID-19V-V ECMO cohort. Methods: We validated ECMOnet, PRESET (PREdiction of Survival on ECMO Therapy-Score), Roch, SOFA (Sequential Organ Failure Assessment), APACHE II (acute physiology and chronic health evaluation), 4C (Coronavirus Clinical Characterisation Consortium), and CURB-65 (Confusion, Urea nitrogen, Respiratory Rate, Blood Pressure, age>65 years) scores on the ISARIC (International Severe Acute Respiratory and emerging Infection Consortium) database. We report discrimination via Area Under the Receiver Operative Curve (AUROC) and Area under the Precision Recall Curve (AURPC) and calibration via Brier score. Results: We included 1147 patients and scores were calculated on patients with sufficient variables. ECMO mortality scores had AUROC (0.58–0.62), AUPRC (0.62–0.74), and Brier score (0.286–0.303). Roch score had the highest accuracy (AUROC 0.62), precision (AUPRC 0.74) yet worst calibration (Brier score of 0.3) despite being calculated on the fewest patients (144). Severity of illness scores had AUROC (0.52–0.57), AURPC (0.59–0.64), and Brier Score (0.265–0.471). APACHE II had the highest accuracy (AUROC 0.58), precision (AUPRC 0.64), and best calibration (Brier score 0.26). Conclusion: Within a large international multicenter COVID-19 cohort, the evaluated ECMO mortality prediction and severity of illness scores demonstrated inconsistent discrimination and calibration highlighting the need for better clinically applicable decision support tools.
dc.description.statementofresponsibilityNeel Shah, Bing Xue, Ziqi Xu, Hanqing Yang, Eva Marwali, Heidi Dalton, Philip P. R. Payne, Chenyang Lu, Ahmed S. Said, ISARIC Clinical Characterisation Group
dc.identifier.citationArtificial Organs, 2023; 47(9):1490-1502
dc.identifier.doi10.1111/aor.14542
dc.identifier.issn0160-564X
dc.identifier.issn1525-1594
dc.identifier.urihttps://hdl.handle.net/2440/143936
dc.language.isoen
dc.publisherWILEY
dc.relation.granthttp://purl.org/au-research/grants/arc/CE170100009
dc.rights© 2023 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
dc.source.urihttp://dx.doi.org/10.1111/aor.14542
dc.subjectARDS; COVID-19; ECLS; extracorporeal life support; extracorporeal membrane oxygenation; mortality; prediction scores; Sars-Cov2; V-V ECMO
dc.subject.meshHumans
dc.subject.meshExtracorporeal Membrane Oxygenation
dc.subject.meshAPACHE
dc.subject.meshRetrospective Studies
dc.subject.meshAged
dc.subject.meshPandemics
dc.subject.meshCOVID-19
dc.titleValidation of extracorporeal membrane oxygenation mortality prediction and severity of illness scores in an international COVID-19 cohort
dc.typeJournal article
pubs.publication-statusPublished

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