Supplementary Material for: Long-Term Clinical Outcomes of Acute Kidney Disease in Patients Receiving Extracorporeal Membrane Oxygenation

Introduction: Extracorporeal membrane oxygenation (ECMO) is widely used; however, studies on the long-term outcomes of ECMO are scarce. We investigated the long-term clinical outcomes of acute kidney disease (AKD) in patients receiving ECMO.
Methods: Electronic data (2009–2018) were retrospectively collected from a multicenter database. Patients were divided into two groups (AKD and non-AKD) according to their AKD status 8–90 days after the initiation of ECMO. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between the two groups. The primary outcomes were major adverse kidney events (MAKEs) and major adverse cardiovascular events (MACEs), and the secondary outcomes were all-cause readmission, sepsis-related readmission, infection-related readmission, and dementia.
Results: Total 395 patients were eligible for analysis; of them, 160 patients (40.5%) developed AKD. The AKD group had a higher risk of MAKEs (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.68–2.53) than did the non-AKD group. Subgroup analysis revealed that the observed unfavorable effect of AKD on the risk of MAKEs was more pronounced in patients receiving venovenous ECMO than in those receiving venoarterial ECMO (HR: 5.69 vs. 1.85, respectively; P for interaction = 0.004). AKD group had a higher risk of MACE during the initial 3-year post- ECMO in comparison to those without (HR: 1.68; 95% CI: 1.22–2.30). Moreover, the risks of all-cause, sepsis-related, and infection-related readmissions were high in AKD survivors.
Conclusions: AKD is associated with an increased risk of long-term MAKEs and initial 3-year MACE in ECMO recipients. In addition, AKD is associated with increased risks of all-cause, infection-related, and sepsis-related readmissions.

引言：体外膜肺氧合（Extracorporeal membrane oxygenation, ECMO）临床应用广泛，但有关其长期预后的相关研究仍较为匮乏。本研究旨在探讨接受体外膜肺氧合治疗的患者发生急性肾病（Acute Kidney Disease, AKD）后的长期临床结局。
方法：回顾性收集2009—2018年多中心数据库中的电子病历数据。根据体外膜肺氧合启动后8~90天的急性肾病状态，将患者分为急性肾病组与非急性肾病组。采用治疗加权逆概率（Inverse Probability of Treatment Weighting, IPTW）平衡两组间的基线协变量。本研究的主要结局为主要不良肾脏事件（Major Adverse Kidney Events, MAKEs）与主要不良心血管事件（Major Adverse Cardiovascular Events, MACEs）；次要结局包括全因再入院、脓毒症相关再入院、感染相关再入院及痴呆。
结果：最终共有395例患者符合分析纳入标准，其中160例（40.5%）发生急性肾病。与非急性肾病组相比，急性肾病组患者的主要不良肾脏事件发生风险更高（风险比[HR]：2.06；95%置信区间[CI]：1.68~2.53）。亚组分析显示，在接受静脉-静脉体外膜肺氧合（venovenous ECMO）的患者中，急性肾病对主要不良肾脏事件风险的不利影响较接受静脉-动脉体外膜肺氧合（venoarterial ECMO）的患者更为显著（风险比分别为5.69与1.85；交互效应P值=0.004）。在体外膜肺氧合治疗后的初始3年内，急性肾病组患者的主要不良心血管事件发生风险高于非急性肾病组（HR：1.68；95%CI：1.22~2.30）。此外，急性肾病存活患者的全因、感染相关及脓毒症相关再入院风险均显著升高。
结论：接受体外膜肺氧合治疗的患者中，急性肾病与长期主要不良肾脏事件风险升高及治疗后初始3年内主要不良心血管事件风险增加显著相关。此外，急性肾病还与全因、感染相关及脓毒症相关再入院风险升高存在关联。