Thrombosis research · 2026
Prognostic indicators in VA-ECMO: Insights from thromboinflammatory markers.
СтатьяНазвание и аннотация: Перевод в очереди
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Pei Shengqiang, Xu Jie, Chen Zixin, Song Danyu, Bayartaikishigtai Dabuxilite, Liu Jiayue, Zhang Zhihan, Ji Bingyang, Yan Shujie, Zhou Zhou, Zhang Yang
Аннотация
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving intervention for refractory cardiogenic shock but is frequently complicated by thromboinflammation, leading to high morbidity and mortality. Neutrophil extracellular traps (NETs) and S100A8/A9 are involved in the thromboinflammatory process, yet their value as prognostic biomarkers for adverse outcomes in VA-ECMO patients remains to be further elucidated.
OBJECTIVE: This study aimed to investigate the dynamic changes of NETs and S100A8/A9 in VA-ECMO patients and evaluate their predictive value for adverse outcomes.
METHODS: A prospective cohort of 24 critically ill patients undergoing VA-ECMO was consecutively enrolled. Plasma levels of CitH3, dsDNA, and S100A8/A9 were measured at three predefined time points: baseline, 48 h post-initiation, and pre-decannulation. Their associations with adverse clinical outcomes were analyzed. Additionally, DNaseI intervention was employed in rat VA-ECMO models to further validate the mechanistic role of NETs.
RESULTS: During VA-ECMO support, the thromboinflammatory markers S100A8/A9 and CitH3 remained persistently elevated, with significantly higher concentrations observed in the withdrawal group (54.2%) compared to the successful weaning group. Spearman's correlation analysis indicated significant positive associations between S100A8/A9, CitH3, dsDNA, and the withdrawal of ECMO support. ROC curve analysis demonstrated that these markers were superior to traditional indicators, such as C-reactive protein, in predicting the withdrawal of ECMO support. Multivariate Cox regression analysis identified CitH3 serve as better prognostic indicators in patients undergoing VA-ECMO. In a rat VA-ECMO model, DNaseI treatment effectively reduced S100A8/A9 levels, while significantly extending the duration of ECMO support, thereby providing proof-of-concept for NETs-targeted therapy.
CONCLUSION: NETs-associated thromboinflammatory markers are closely associated with adverse outcomes in VA-ECMO patients and offer better prognostic value compared to traditional biomarkers. Targeting NETs may represent a promising therapeutic strategy to mitigate the thromboinflammatory burden and improve patient prognosis.
OBJECTIVE: This study aimed to investigate the dynamic changes of NETs and S100A8/A9 in VA-ECMO patients and evaluate their predictive value for adverse outcomes.
METHODS: A prospective cohort of 24 critically ill patients undergoing VA-ECMO was consecutively enrolled. Plasma levels of CitH3, dsDNA, and S100A8/A9 were measured at three predefined time points: baseline, 48 h post-initiation, and pre-decannulation. Their associations with adverse clinical outcomes were analyzed. Additionally, DNaseI intervention was employed in rat VA-ECMO models to further validate the mechanistic role of NETs.
RESULTS: During VA-ECMO support, the thromboinflammatory markers S100A8/A9 and CitH3 remained persistently elevated, with significantly higher concentrations observed in the withdrawal group (54.2%) compared to the successful weaning group. Spearman's correlation analysis indicated significant positive associations between S100A8/A9, CitH3, dsDNA, and the withdrawal of ECMO support. ROC curve analysis demonstrated that these markers were superior to traditional indicators, such as C-reactive protein, in predicting the withdrawal of ECMO support. Multivariate Cox regression analysis identified CitH3 serve as better prognostic indicators in patients undergoing VA-ECMO. In a rat VA-ECMO model, DNaseI treatment effectively reduced S100A8/A9 levels, while significantly extending the duration of ECMO support, thereby providing proof-of-concept for NETs-targeted therapy.
CONCLUSION: NETs-associated thromboinflammatory markers are closely associated with adverse outcomes in VA-ECMO patients and offer better prognostic value compared to traditional biomarkers. Targeting NETs may represent a promising therapeutic strategy to mitigate the thromboinflammatory burden and improve patient prognosis.