SAVE、APACHEⅡ评分联合循环生物标志物预测经静脉-动脉体外膜肺氧合治疗AMICS患者90天生存预后中的临床应用价值

doi:10.3969/j.issn.1006-5725.2026.04.022

Abstract

Abstract:

Objective Exploring the clinical application value of combining the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation （SAVE） score， the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score， and circulatory biomarkers in predicting 90-day survival outcomes in patients with acute myocardial infarction complicated by cardiogenic shock （AMICS） treated with veno-arterial extracorporeal membrane oxygenation （VA-ECMO）. Methods A total of 136 patients with amics admitted to the hospital from September 2020 to September 2024 were selected as the objects. All patients were treated with VA-ECMO， and were followed up for 90 days （the start time of follow-up was the day of VA-ECMO catheterization）. The survival status of the patients was observed， and they were divided into survival group and death group according to the survival status.General clinical data， SAVE scores， APACHE Ⅱ scores， and levels of low-density lipoprotein （LDL）， lactate， C-reactive protein （CRP）， cardiac troponin 1（cTn1）， and brain natriuretic peptide （BNP） were compared between the two groups. Multivariate Cox regression analysis was employed to identify factors influencing mortality in AMICS patients treated with VA-ECMO. Receiver operating characteristic （ROC） curve analysis was conducted to evaluate the clinical value of relevant indicators in predicting 90-day survival outcomes. Survival curves were generated using the Kaplan?Meier method， and the Log-rank test was used to compare survival differences between groups. Result Among 136 patients， a total of 63 died within 90 days， with a mortality rate of 46.32%； The death group was older than the survival group， with higher levels of APACHE Ⅱ score， low-density lipoprotein， lactate， CRP， cTn1， and BNP compared to the survival group， and lower levels of high-density lipoprotein and SAVE score compared to the survival group （P < 0.05）； Cox regression analysis showed that SAVE score， APACHE Ⅱ score， lactate， CRP， and cTn1 were all influencing factors for 90 day mortality in AMICS patients after VA-ECMO treatment （P < 0.05）； ROC curve analysis showed that the AUC value of the combined detection of SAVE score， APACHE Ⅱ score， lactate， CRP， and cTn1 in evaluating the 90 day mortality risk of VA-ECMO treatment for AMICS patients was higher than that of single detection （Z = 5.731， 3.573， 5.544， 5.983， 4.807， P<0.05）； Kaplan Meier curves showed that patients with SAVE score ≤ -4.301， APACHE Ⅱ score > 25.076， lactate > 3.900 mmol/L， CRP > 23.752 mg/L， and cTn1 > 7.755 ng/mL had shorter survival times （Log rank chi square =16.573， 4.028， 61.746， 22.375， 28.635， P < 0.001）. Conclusion The combined detection of SAVE score， APACHE Ⅱ score， lactate， CRP， and cTn1 has a high efficacy in evaluating the 90 day mortality risk of VA-ECMO treatment for AMICS patients.

Key words: SAVE rating, Acute Physiology and Chronic Health Status Score Ⅱ, circulating biomarkers, transvenous arterial extracorporeal membrane oxygenation, acute myocardial infarction, cardiogenic shock

CLC Number:

R541.1

Shu ZHOU,Shuhan YANG,Zengxia WANG,Xuening WANG,Ruihan FENG,Lili PENG,Meiling YANG. The clinical application value of SAVE， APACHEⅡ score combined with circulating biomarkers in predicting the 90 day survival prognosis of patients with AMICS treated with VA-ECMO[J]. The Journal of Practical Medicine, 2026, 42(4): 698-705.

Figures/Tables 11

Tab.1

Comparison of general information between survival group and death group"

项目	死亡组（n = 63）	生存组（n = 73）	χ2/t值	P值	MD（95% CI）
性别/例			0.174	0.676
男	34	42
女	29	31
年龄/岁	72.06 ± 5.62	70.03 ± 5.09	2.233	0.027	2.03（0.21 ~ 3.85）
BMI/（kg/m²）	22.47 ± 2.36	22.28 ± 2.20	0.490	0.625	0.19（-0.050 ~ 0.88）
文化程度/［例（%）］			0.164	0.685
高中及以下	46（73.02）	51（69.86）
大专及以上	17（26.98）	22（30.14）
居住地/［例（%）］			0.309	0.578
城镇	54（85.72）	60（82.19）
农村	9（14.28）	13（17.81）
高血压/［例（%）］	29（46.03）	36（49.32）	0.146	0.702
糖尿病/［例（%）］	27（42.85）	33（45.21）	0.076	0.782
高血脂/［例（%）］	20（31.75）	24（32.87）	0.020	0.888
吸烟史/［例（%）］	27（42.85）	26（35.62）	0.745	0.389
饮酒史/［例（%）］	23（36.51）	25（34.25）	0.075	0.783
血糖/（mmol/L）	4.18 ± 0.58	4.24 ± 0.54	0.631	0.529	-0.06（-0.24 ~ 0.12）
收缩压/mmHg	138.24 ± 10.73	138.02 ± 10.56	0.121	0.904	0.22（-3.54 ~ 3.98）
舒张压/mmHg	86.43 ± 7.42	86.08 ± 7.13	0.283	0.778	0.35（-2.07 ~ 2.77）
心率/（次/min）	95.27 ± 10.65	95.43 ± 10.57	0.088	0.930	-0.16（-3.92 ~ 3.60）
SAVE评分/分	-6.84 ± 3.46	-4.03 ± 3.17	5.444	< 0.001	-2.81（-4.09 ~ 1.53）
APACHE Ⅱ评分/分	26.64 ± 3.28	24.13 ± 2.94	4.754	< 0.001	2.51（1.32 ~ 3.70）
血红蛋白/（g/L）	122.37 ± 10.73	123.08 ± 10.96	0.384	0.702	-0.71（-4.35 ~ 2.93）
血钾/（mmol/L）	3.28 ± 0.65	3.30 ± 0.66	0.179	0.858	-0.02（-0.25 ~ 0.21）
血钠/（mmol/L）	135.22 ± 5.53	135.17 ± 5.41	0.055	0.956	0.05（-1.83 ~ 1.93）
血钙/（mmol/L）	2.52 ± 0.17	2.54 ± 0.19	0.648	0.518	-0.02（-0.08 ~ 0.04）
血磷/（mmol/L）	1.34 ± 0.14	1.33 ± 0.13	0.436	0.664	0.01（-0.03 ~ 0.05）
总胆固醇/（mmol/L）	4.65 ± 0.71	4.52 ± 0.62	1.152	0.251	0.13（-0.10 ~ 0.36）
甘油三酯/（mmol/L）	1.34 ± 0.26	1.28 ± 0.23	1.443	0.151	0.06（-0.01 ~ 0.13）
低密度脂蛋白/（mmol/L）	2.64 ± 0.30	2.52 ± 0.28	2.435	0.016	0.12（0.02 ~ 0.22）
高密度脂蛋白/（mmol/L）	1.37 ± 0.28	1.48 ± 0.33	2.094	0.038	-0.11（-0.22 ~ 0.00）
乳酸/（mmol/L）	4.15 ± 0.83	3.54 ± 0.72	4.639	< 0.001	0.61（0.35 ~ 0.87）
CRP/（mg/L）	24.73 ± 2.72	22.82 ± 2.29	4.495	< 0.001	1.91（1.08 ~ 2.74）
cTn1/（ng/mL）	7.93 ± 0.96	7.15 ± 0.93	4.851	< 0.001	0.78（0.41 ~ 1.15）
BNP/（pg/mL）	436.62 ± 46.52	403.78 ± 39.21	4.521	< 0.001	32.84（16.23 ~ 49.45）

Tab.1

Tab.2

Tab.3

Fig.1

Tab.4

Fig.2

Fig.3

Fig.4

Fig.5

Fig.6

Fig.7

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自变量	赋值
年龄	原值
SAVE评分	原值
APACHE Ⅱ评分	原值
低密度脂蛋白	原值
高密度脂蛋白	原值
乳酸	原值
CRP	原值
cTn1	原值
BNP	原值

因素	B	SE	Wald	P值	HR	95%CI
年龄	0.007	0.046	0.021	0.885	1.007	0.920 ~ 1.101
SAVE评分	-0.142	0.062	5.181	0.023	0.867	0.768 ~ 0.980
APACHEⅡ评分	0.550	0.091	30.600	< 0.001	1.652	1.383 ~ 1.973
低密度脂蛋白	-0.792	0.744	1.132	0.287	0.453	0.105 ~ 1.948
高密度脂蛋白	-0.635	0.791	0.645	0.422	0.530	0.112 ~ 2.498
乳酸	1.162	0.331	2.322	< 0.001	3.195	1.670 ~ 6.111
CRP	0.463	0.104	19.655	< 0.001	1.589	1.295 ~ 1.950
cTn1	0.876	0.246	12.669	< 0.001	2.400	1.482 ~ 3.887
BNP	0.007	0.005	1.565	0.211	1.007	0.996 ~ 1.017

指标	AUC	标准误差	95% CI	P值	cut-off值	约登指数	敏感度/%	特异度/%
SAVE评分	0.678^*	0.046	0.593 ~ 0.756	< 0.001	≤ -4.301分	0.293	84.13	45.21
APACHE Ⅱ评分	0.845^*	0.033	0.773 ~ 0.901	< 0.001	> 25.076分	0.528	85.71	67.12
乳酸	0.695^*	0.045	0.610 ~ 0.771	< 0.001	> 3.900 mmol/L	0.295	65.08	64.38
CRP	0.670^*	0.046	0.584 ~ 0.748	< 0.001	> 23.752 mg/L	0.256	57.14	68.49
cTn1	0.756^*	0.041	0.675 ~ 0.825	< 0.001	> 7.755 ng/mL	0.411	60.32	80.82
联合检测	0.941	0.018	0.888 ~ 0.974	< 0.001	> 0.532	0.754	90.48	84.93
Z_{SAVE评分-联合检测}	5.731
Z_{APACHE II评分-联合检测}	3.573
Z_{乳酸-联合检测}	5.544
Z_{CRP-联合检测}	5.983
Z_{cTn1-联合检测}	4.807

The clinical application value of SAVE， APACHEⅡ score combined with circulating biomarkers in predicting the 90 day survival prognosis of patients with AMICS treated with VA-ECMO

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