TY - JOUR
T1 - Validation of extracorporeal membrane oxygenation mortality prediction and severity of illness scores in an international COVID-19 cohort
AU - ISARIC Clinical Characterisation Group
AU - Shah, Neel
AU - Xue, Bing
AU - Xu, Ziqi
AU - Yang, Hanqing
AU - Marwali, Eva
AU - Dalton, Heidi
AU - Payne, Philip P.R.
AU - Lu, Chenyang
AU - Said, Ahmed S.
AU - Abdukahil, Sheryl Ann
AU - Abdulkadir, Nurul Najmee
AU - Absil, Lara
AU - Acker, Andrew
AU - Adrião, Diana
AU - Hssain, Ali Ait
AU - Akwani, Chika
AU - Qasim, Eman Al
AU - Alalqam, Razi
AU - Al-Dabbous, Tala
AU - Alex, Beatrice
AU - Al-Fares, Abdulrahman
AU - Alfoudri, Huda
AU - Aliudin, Jeffrey
AU - Alves, João
AU - Alves, Rita
AU - Alves, João Melo
AU - Cabrita, Joana Alves
AU - Amaral, Maria
AU - Amira, Nur
AU - Andini, Roberto
AU - Anthonidass, Sivanesen
AU - Antonelli, Massimo
AU - Arabi, Yaseen
AU - Arcadipane, Antonio
AU - Arenz, Lukas
AU - Arnold-Day, Christel
AU - Arora, Lovkesh
AU - Arora, Rakesh
AU - Ashraf, Muhammad
AU - Asyraf, Amirul
AU - Atique, Anika
AU - Bach, Benjamin
AU - Baillie, John Kenneth
AU - Bak, Erica
AU - Bakar, Nazreen Abu
AU - Balakrishnan, Mohanaprasanth
AU - Barbalho, Renata
AU - Barclay, Wendy S.
AU - Barnett, Saef Umar
AU - Nonas, Stephanie
N1 - Publisher Copyright:
© 2023 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - ARDS
KW - COVID-19
KW - ECLS
KW - Sars-Cov2
KW - V-V ECMO
KW - extracorporeal life support
KW - extracorporeal membrane oxygenation
KW - mortality
KW - prediction scores
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U2 - 10.1111/aor.14542
DO - 10.1111/aor.14542
M3 - Article
C2 - 37032544
AN - SCOPUS:85157988558
SN - 0160-564X
VL - 47
SP - 1490
EP - 1502
JO - Artificial Organs
JF - Artificial Organs
IS - 9
ER -