Immune-Based Biomarkers as Predictors of Mortality in ECMO Therapy for Severe COVID-19 ARDS: Insights from a Retrospective Study

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe respiratory failure, particularly those with acute respiratory distress syndrome (ARDS) unresponsive to conventional therapy. However, optimal patient selection for ECMO remains a major clinical challenge. This study aimed to identify novel immune-based biomarkers to refine eligibility assessment and predict outcomes in critically ill COVID-19 patients receiving ECMO.The analysis revealed a 5.56-fold increased mortality risk in patients exhibiting a specific immune signature characterized by T-cell exhaustion, low interferon-alpha (IFN-alpha) levels, and elevated calprotectin concentrations. These immune markers were strongly associated with poorer clinical outcomes among ECMO-treated patients.Our findings underscore the pivotal role of immune profiling in both ECMO patient selection and outcome prediction. Integrating immune-based biomarkers into clinical decision-making may enhance the assessment of ECMO candidacy and guide personalized treatment strategies, ultimately improving survival and recovery.