Author
Affilliation
Abstract
Background: Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a lifesaving support modality for severe respiratory failure, but its resource-intensive 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-19 V-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.
Publisher
International Society for Artificial Organs
Citation
SHAH, Neel et al. Validation of extracorporeal membrane oxygenation mortality prediction and severity of illness scores in an international COVID-19 cohort. Artificial Organs, v. 47, n. 9, p. 1490-1502, Sept. 2023.
DOI
10.1111/aor.14542
ISSN
0160-564X
Notes
Fernando Augusto Bozza - Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
ISARIC Clinical Characterisation Group: Sheryl Ann Abdukahil, Nurul Najmee Abdulkadir, Lara Absil, Andrew Acker, Diana Adrião, Ali Ait Hssain, Chika Akwani, Eman Al Qasim, Razi Alalqam, Tala Al-Dabbous, Beatrice Alex, Abdulrahman Al-Fares, Huda Alfoudri, Jeffrey Aliudin, João Alves, Rita Alves, João Melo Alves, Joana Alves Cabrita, Maria Amaral, Nur Amira, Roberto Andini, Sivanesen Anthonidass, Massimo Antonelli, Yaseen Arabi, Antonio Arcadipane, Lukas Arenz, Christel Arnold-Day, Lovkesh Arora, Rakesh Arora, Muhammad Ashraf, Amirul Asyraf, Anika Atique, Benjamin Bach, John Kenneth Baillie, Erica Bak, Nazreen Abu Bakar, Mohanaprasanth Balakrishnan, Renata Barbalho, Wendy S Barclay, Saef Umar Barnett, Michaela Barnikel, Helena Barrasa, Cleide Barrigoto, Joaquín Baruch, Muhammad Fadhli Hassin Basri, Denise Battaglini, Diego Fernando Bautista Rincon, Ker Hong Bee, Husna Begum, Aleksandr Beljantsev, Lionel Eric Benjiman, Luís Bento, José Luis Bernal Sobrino, Lorenzo Bertolino, Amar Bhatt, Claudia Bianco, Farah Nadiah Bidin, Felwa Bin Humaid, Mohd Nazlin Bin Kamarudin, Pablo Blanco-Schweizer, Frank Bloos, Filomena Boccia, Debby Bogaert, Diogo Borges, Dounia Bouhmani, Jason Bouziotis, Maria Boylan, Fernando Augusto Bozza, Luca Brazzi, David Brewster, Kathy Brickell, Tessa Broadley, Nicolas Brozzi, Nina Buchtele, Aidan Burrell, Susana Cabral, Joana Cabrita, Rui Caetano Garcês, Kate Calligy, Paul Campbell, Sofia Cardoso, Filipe Cardoso, Filipa Cardoso, Simone Carelli, François Martin Carrier, Gail Carson, Mariana Cascão, José Casimiro, Nidyanara Castanheira, Ivo Castro, Ana Catarino, Roberta Cavalin, Giulio Giovanni Cavalli, Alexandros Cavayas, Meera Chand, Anjellica Chen, Yih-Sharng Chen, Matthew Pellan Cheng, Julian Chica, Suresh Kumar Chidambaram, Leong Chin Tho, Sung-Min Cho, Ting Soo Chow, Hiu Jian Chua, Jonathan Chua, Jose Pedro Cidade, Barbara Wanjiru Citarella, Anna Ciullo, Jennifer Clarke, Sara Clohisey, Cassidy Codan, Jennifer Coles, Sebastiano Maria Colombo, Marie Connor, Graham S Cooke, Amanda Corley, Sabine Cornelis, Arianne Joy Corpuz, Jonathan Crump, Claudina Cruz, Juan Luis Cruz Bermúdez, Jaime Cruz Rojo, Marc Csete, Ailbhe Cullen, Matthew Cummings, Gerard Curley, Paula Custodio, Ana da Silva Filipe, Al-Awwab Dabaliz, Andrew Dagens, Darren Dahly, Heidi Dalton, Jo Dalton, Juliana Damas, Emmanuelle A Dankwa, Jorge Dantas, Gillian de Loughry, Rosanna De Rosa, Thushan de Silva, Jillian Deacon, David Dean, Bianca DeBenedictis, Andrea Dell'Amore, Emmanuelle Denis, Pieter Depuydt, Mehul Desai, Pathik Dhangar, Rodrigo Diaz, Wim Dieperink, Annemarie B Docherty, Helen Doherty, Christl A Donnelly, Chloe Donohue, Triona Downer, Thomas Drake, Toni Duculan, Jake Dunning, Mathilde Duplaix, Emanuele Durante-Mangoni, Lucian Durham, Sim Choon Ean, Marco Echeverria-Villalobos, Loubna Elotmani, Tarek Elshazly, Chan Chee Eng, Martina Escher, Catarina Espírito Santo, João Estevão, Anna Greti Everding, Cameron J Fairfield, Pedro Faria, Hanan Fateena, Mohamed Fayed, Jorge Fernandes, Marília Andreia Fernandes, Susana Fernandes, Joana Ferrão, Mário Ferraz, Bernardo Ferreira, Benigno Ferreira, Claudia Figueiredo-Mello, Juan Fiorda, Tom Fletcher, Letizia Lucia Florio, Tatiana Fonseca, Simon Forsyth, Giuseppe Foti, Robert A Fowler, John F Fraser, Christophe Fraser, Ana Freitas Ribeiro, Craig French, Masahiro Fukuda, G Argin, Massimo Gagliardi, Sérgio Gaião, Carrol Gamble, Yasmin Gani, Rebekha Garcia, Noelia García Barrio, Aisling Gavin, Nuno Germano, Marco Giani, Elaine Gilroy, Michelle Girvan, Eric Gnall, Jean-Christophe Goffard, Jin Yi Goh, Jonathan Golob, Alicia Gonzalez, Jeronimo Graf, Giacomo Grasselli, Christopher A Green, William Greenhalf, Domenico Luca Grieco, Matthew Griffee, Fiona Griffiths, Anja Grosse Lordemann, Heidi Gruner, Yusing Gu, Daniela Guerreiro, Maisa Guimarães de Castro, Sheeba Hakak, Matthew Hall, Sophie Halpin, Ansley Hamer, Terese Hammond, Naomi Hammond, Lim Yuen Han, Kok Wei Hao, Hayley Hardwick, Samuel Bernard Ekow Harrison, Ewen M Harrison, Janet Harrison, Jan Heerman, Ross Hendry, Martina Hennessy, Dawn Higgins, Rupert Higgins, Samuel Hinton, Yi Bin Ho, Antonia Ho, Wei Han Hoh, Rebecca Holt, Peter Horby, Jimmy Ming-Yang Hsu, Abby Hurd, Samreen Ijaz, Hugo Inácio, Yun Sii Ing, Sarah Isgett, Tiago Isidoro, Nadiah Ismail, Daniel Ivulich, Clare Jackson, Anilawati Mat Jelani, Ong Yiaw Joe, Swosti Joshi, Anna Jung, Neerusha Kaisbain, Thavamany Kaleesvran, Muhammad Aisar Ayadi Kamaluddin, Zul Amali Che Kamaruddin, Nadiah Kamarudin, Kong Yeow Kang, Pratap Karpayah, Christiana Kartsonaki, Christy Kay, Seán Keating, Andrea Kelly, Aoife Kelly, Sadie Kelly, Kalynn Kennon, Imrana Khalid, Irfan Khan, Michelle E Kho, Ryan Khoo, Denisa Khoo, Saye Khoo, Khor How Kiat, Yuri Kida, Jae Burm Kim, Nobuya Kitamura, Paul Klenerman, Stephen R Knight, Robin Kobbe, Vinothini Krishnan, Deepali Kumar, Ganesh Kumar, Ethan Kurtzman, Antonio Lalueza, Marina Lanza, Andy Law, Todd C Lee, Heng Gee Lee, Biing Horng Lee, Yi Lin Lee, James Lee, Jennifer Lee, Gary Leeming, Ha Sha Lene, Michela Leone, Gianluigi Li Bassi, Kah Chuan Lim, Wei Shen Lim, Lim Lina, Keibun Liu, Antonio Loforte, Leong Chee Loon, Diogo Lopes, Lee Lee Low, Jia Shyi Loy, Carlos Lumbreras Bermejo, Miles Lunn, Ruth Lyons, Olavi Maasikas, Sara Machado, Guillermo Maestro de la Calle, Lars S Maier, Maximilian Malfertheiner, Nadia Malik, Ceila Maria Sant'Ana Malaque, Daniel Marino, Ana Marques, Brian Marsh, Laura Marsh, John Marshall, Emily Martin, F Eduardo Martinez, Ignacio Martin-Loeches, João Martins, Ana Martins, Caroline Martins Rego, Gennaro Martucci, Marsilla Marzukie, Javier Maynar, Colin McArthur, Peter McCanny, Colin McCloskey, Sherry McDermott, Sarah E McDonald, Aine McElroy, Samuel McElwee, Natalie McEvoy, Chris McKay, Johnny McKeown, Kenneth A McLean, Ferruccio Mele, Ogechukwu Menkiti, Alexander J Mentzer, Blake Mergler, Laura Merson, António Mesquita, Alison M Meynert, Vladislav Mihnovit, Jennene Miller, Nor Arisah Misnan, Tahira Jamal Mohamed, Nik Nur Eliza Mohamed, Asma Moin, Mary Mone, Agostinho Monteiro, Claudia Montes, Giorgia Montrucchio, Shona C Moore, Sarah Moore, Ana Motos, Ng Yong Muh, Dzawani Muhamad, Aisling Murphy, Srinivas Murthy, Gugapriyaa Muyandy, Dave Nagpal, Alex Nagrebetsky, Raul Neto, Emily Neumann, Wing Yiu Ng, Orna Ni Choileain, Alistair D Nichol, Prompak Nitayavardhana, Stephanie Nonas, Nurul Amani Mohd Noordin, Nurul Faten Izzati Norharizam, Lisa Norman, Mahdad Noursadeghi, Giovanna Occhipinti, Max O'Donnell, Takayuki Ogura, João Oliveira, Piero L Olliaro, Jee Yan Ong, Wilna Oosthuyzen, Peter Openshaw, Jamel Ortoleva, Javier Osatnik, Siti Zubaidah Othman, Massimo Palmarini, Giovanna Panarello, Prasan Kumar Panda, Lai Hui Pang, Mauro Panigada, Rachael Parke, Fabian Patauner, Mohan Dass Pathmanathan, Lisa Patterson, Jorge Paulos, William A Paxton, Sandra L Peake, Kalaiarasu Peariasamy, Miguel Pedrera Jiménez, Paolo Pelosi, Rui Pereira, Luis Periel, Antonio Pesenti, Carlos Pimentel, Catarina Pires, Riinu Pius, Hon Shen Png, Sergio Poli, Georgios Pollakis, Andra-Maris Post, Douwe F Postma, Pedro Povoa, Diana Póvoas, Jean-Charles Preiser, Mark G Pritchard, Lucia Proença, Bambang Pujo Semedi, Luisa Quesada, Vilmaris Quinones-Cardona, Víctor Quirós González, Mohammed Quraishi, Aldo Rafael, Rozanah Abd Rahman, Ahmad Kashfi Haji Ab Rahman, Giri Shan Rajahram, José Ramalho, Ahmad Afiq Ramli, Grazielle Viana Ramos, Rajavardhan Rangappa, Indrek Rätsep, Cornelius Rau, Tharmini Ravi, Renato Reis, Jordi Rello, Hongru Ren, David Richardson, Siti Nurul Atikah Ahmad Ridzuan, Ana L Rios, Chiara Robba, André Roberto, Stephanie Roberts, David L Robertson, Simão Rodeia, Bernhard Roessler, Claire Roger, Amanda Rojek, Roberto Roncon-Albuquerque, Michael Rose, Dorothea Rosenberger, Matteo Rossetti, Clark D Russell, Steffi Ryckaert, Isabela Saba, Musharaf Sadat, Pranya Sakiyalak, Leonardo Salazar, Gabriele Sales, Emely Sanchez, Vanessa Sancho-Shimizu, Gyan Sandhu, Marlene Santos, Sree Satyapriya, Egle Saviciute, Yen Tsen Saw, Justin Schaffer, Tjard Schermer, Michael Schwameis, Janet T Scott, James Scott-Brown, Mageswari Selvarajoo, Malcolm G Semple, Rasidah Bt Senian, Filipa Sequeira, Tânia Sequeira, Ary Serpa Neto, Pablo Serrano Balazote, Syamin Asyraf Shahidan, Mohammad Shamsah, Pratima Sharma, Catherine A Shaw, Victoria Shaw, Rajesh Mohan Shetty, Haixia Shi, Hiroaki Shimizu, Keiki Shimizu, Sally Shrapnel, Hoi Ping Shum, Ng Yong Siang, Louise Sigfrid, Piret Sillaots, Catarina Silva, Benedict Sim Lim Heng, Punam Singh, Mahendra Singh, Karisha Sivam, Sue Smith, Benjamin Smood, Coilin Smyth, Morgane Snacken, Tze Vee Soh, Joshua Solomon, Tom Solomon, Emily Somers, Myung Jin Song, Marta Sousa, Maria Sousa Uva, Alexandra Sperry, Shiranee Sriskandan, Thomas Staudinger, Stephanie-Susanne Stecher, Ymkje Stienstra, Eva Stolz, Ami Stuart, David Stuart, Jacky Y Suen, Charlotte Summers, Deepashankari Suppiah, Sarah Syahrin, Jaques Sztajnbok, Konstanty Szuldrzynski, Shirin Tabrizi, Fabio S Taccone, Shahdattul Mawarni Taib, Sara Taleb, Jelmer Talsma, Kim Keat Tan, Yan Chyi Tan, Richard S Tedder, Tze Yuan Tee, João Teixeira, Sofia Tejada, Sze Kye Teoh, Pleun Terpstra, Hubert Tessier-Grenier, Alif Adlan Mohd Thabit, Zhang Duan Tham, Suvintheran Thangavelu, Jananee Thirumanickam, Shaun Thompson, David Thomson, Emma C Thomson, Mathew Thorpe, Surain Raaj Thanga Thurai, Ryan S Thwaites, Jordan Zhien Yang Toh, Sia Loong Tonnii, Marta Torre, Antoni Torres, Michael Towers, Tony Trapani, Lance C W Turtle, Andrew Udy, Roman Ullrich, Alberto Uribe, Asad Usman, Timothy M Uyeki, Luís Val-Flores, Stijn Van de Velde, Nicky Van Der Vekens, Peter Van der Voort, Henk Vanoverschelde, Shoban Raj Vasudayan, Shaminee Veeran, Sara Ventura, José Ernesto Vidal, César Vieira, Joy Ann Villanueva, Chiara Vitiello, Noor Hidayu Wahab, Suhaila Abdul Wahab, Nadirah Abdul Wahid, Chih-Hsien Wang, Steve Webb, Jia Wei, Tan Pei Wen, Murray Wham, Nicole White, Keith Wille, Bailey Williams, Virginie Williams, Patricia J Williams, Calvin Wong, Xin Ci Wong, Yew Sing Wong, Teck Fung Wong, Gan Ee Xian, Lim Saio Xian, Kuan Pei Xuan, Siti Rohani Binti Mohd Yakop, Masaki Yamazaki, Elizabeth Yarad, Nicholas Yee Liang Hing, Chian Hui Yeoh, Stephanie Yerkovich, Toshiki Yokoyama, Akram Zaaqoq, Masliza Zahid, Nor Zaila Binti Zaidan, Maria Zambon, Alberto Zanella, Nurul Zaynah.
Share