BACKGROUND:Advanced heart failure (advHF) in pediatric patients often requires prolonged mechanical circulatory support (MCS) as a bridge-to-transplant or bridge-to-recovery. Due to donor scarcity and anatomical complexity, pediatric patients frequently face long MCS durations and high complication risks. The Berlin Heart EXCOR is an approved ventricular assist device (VAD) with versatile configurations adaptable to specific patient needs. METHODS:This study analyzed demographic, clinical, echocardiographic, and hemodynamic data from the Heart Transplant Unit at ASST-Papa Giovanni XXIII (Bergamo, Italy). The research focused on advHF management using prolonged MCS as a bridge-to-transplant, detailing Berlin Heart EXCOR configurations, settings, support duration, and complications. RESULTS:Three pediatric patients with distinct etiologies received prolonged MCS via Berlin Heart EXCOR. The first, with genetic dilated cardiomyopathy, required a left ventricular EXCOR. The second, with early-onset cardiomyopathy and biventricular failure, received biventricular support. The third, with complex congenital heart disease (CHD), was supported by a single EXCOR. Despite varying ages and cardiac anatomies, all three patients were successfully bridged to heart transplantation without irreversible extracardiac organ damage. CONCLUSIONS:This case series demonstrates the effectiveness of long-lasting MCS in providing sustained hemodynamic stability for pediatric patients. The Berlin Heart EXCOR proved to be a reliable long-term support option in both univentricular and biventricular settings.
OBJECTIVE:This study investigated the therapeutic effects of Huangqi Jixueteng Decoction (HJD) combined with erythropoietin on iron metabolism in patients with renal anemia undergoing maintenance hemodialysis. METHODS:Sixty patients with renal anemia receiving maintenance hemodialysis were randomly assigned to a Control Group (CG) treated with erythropoietin alone and an Observation Group (OG) treated with erythropoietin plus HJD. Changes in anemia-related indicators (red blood cell (RBC) count, hematocrit (HCT), hemoglobin (Hb)), inflammatory markers (tumor necrosis factor-α (TNF-α), C-reactive protein (CRP)), iron metabolism parameters (serum ferritin (SF), serum iron (SI), total iron-binding capacity (TIBC), transferrin saturation (TSAT)), and renal and hepatic function indicators (blood urea nitrogen (BUN), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST)) were compared between groups. Adverse drug reactions were also monitored. RESULTS:Baseline values showed no significant differences between groups (p > 0.05). Post-treatment, RBC, HCT, and Hb levels increased significantly in both groups (p < 0.05), with greater improvement in the OG (p < 0.05). Inflammatory markers declined in both groups, with CRP and TNF-α levels significantly lower in the OG compared with the CG (p < 0.05). Indicators of iron metabolism (SF, SI, TIBC, TSAT) improved significantly in both groups (p < 0.05), with superior responses in the OG (p < 0.05). Renal and hepatic function indexes (BUN, Scr, AST) decreased post-treatment in both groups, with lower levels in the OG (p < 0.05). No significant differences were observed in adverse reactions such as dizziness, headache, or low-grade fever (p > 0.05). CONCLUSION:The addition of Huangqi Jixueteng Decoction to erythropoietin therapy effectively enhances hematologic parameters, mitigates microinflammation, optimizes iron metabolism, and improves renal function in patients with dialysis-associated renal anemia. This integrative regimen appears safe and well tolerated, offering potential advantages for clinical management of renal anemia.
OBJECTIVE:To determine the incidence of intravascular hemolysis in patients implanted with continuous-flow left ventricular assist devices (LVADs), to describe longitudinal changes in hemolysis-related laboratory markers (LDH, total/direct bilirubin, INR), and to assess their diagnostic value for pump thrombosis and cerebrovascular events. METHODS:We retrospectively analyzed 100 end-stage heart failure patients (2014-2015). To ensure consistent longitudinal analysis, 59 long-term survivors (42 HeartWare HVAD, 17 HeartMate II) were included. For each patient, a dynamic LDH increase ratio (peak/preoperative baseline) was calculated. The diagnostic performance of the criterion "LDH >250 U/L and ⩾4-fold increase from baseline" was evaluated. Cox regression, ROC analysis, and Kaplan-Meier survival analysis were performed. RESULTS:During 1-year follow-up, 17 patients experienced thrombotic or cerebrovascular events (8 confirmed pump thrombosis). While absolute LDH values at fixed time points were not discriminative, the dynamic LDH increase ratio was significantly higher in the thrombosis group (p = 0.0102), with an AUC of 0.840. Preoperative LDH was a significant risk factor in Cox regression (HR: 1.005, p = 0.009), reflecting baseline disease severity. The ⩾4-fold LDH increase criterion demonstrated a Negative Predictive Value (NPV) of 97.6%, indicating excellent rule-out performance. No significant difference was found between device types (p > 0.05), supporting a device-independent biomarker dynamic. CONCLUSION:Baseline LDH alone is not a reliable predictor of pump thrombosis. In contrast, a ⩾4-fold dynamic rise in LDH relative to the patient's own baseline provides excellent negative predictive value. This dynamic surge serves as a practical, device-independent decision-support tool to rule out pump thrombosis with high confidence in all cf-LVAD patients.
BACKGROUND:The withdrawal of the HeartWare HVAD required pediatric mechanical circulatory support programs to transition to alternative durable intracorporeal devices. We evaluated our single-center experience across the HVAD and HeartMate 3 (HM3) eras. METHODS:We retrospectively reviewed all pediatric patients who underwent primary durable intracorporeal LVAD implantation between January 2012 and December 2024. Clinical characteristics, perioperative outcomes, survival on support, bridge-to-transplantation, and device-related adverse events were compared. RESULTS:Thirty-four patients were included: 22 received HVAD and 12 received HM3. Baseline characteristics were generally comparable. Cardiopulmonary bypass time was significantly longer in the HM3 group (p < 0.001). Median support duration was longer with HVAD (1002 vs 838 days; p = 0.304). Survival on LVAD support did not differ between groups (log-rank p = 0.375). Pump thrombosis (40.9% vs 0%; p = 0.013) and ischemic stroke (27.3% vs 0%; p = 0.069) occurred only in HVAD recipients, whereas infectious complications were comparable between groups. CONCLUSIONS:HM3 appears to be a feasible intracorporeal long-term support option for selected pediatric patients in the post-HVAD era. Longer-term multicenter pediatric studies are needed to define durability, late complications, and optimal patient selection.
BACKGROUND:Post-dialysis fatigue is a frequent and burdensome symptom in patients undergoing maintenance hemodialysis. While intradialytic symptoms are commonly monitored in clinical practice, symptoms emerging after dialysis and affecting post-dialysis recovery are often less systematically addressed. This study evaluated the effects of a reduced dialysate temperature on post-dialysis fatigue and thermal comfort. METHODS:This single-group pre-post interventional study was conducted between May and June 2025 at a dialysis center. Of the 220 screened patients, 130 met the eligibility criteria after the predefined clinical exclusions. Patients with Post-Dialysis Fatigue Scale scores ⩾28 were included in the intervention phase (n = 57). The dialysate temperature was reduced from 36.5°C to 36.0°C for three consecutive sessions. Thermal comfort was assessed using a numerical visual analog scale. Data were analyzed using repeated-measures ANOVA, correlation, and regression analyses. RESULTS:Post-dialysis fatigue significantly decreased after the intervention (F = 25.82, p < 0.001; dz = 0.91). Changes in systolic blood pressure independently predicted fatigue improvement (β = -0.557, p = 0.019). Thermal comfort remained stable during the intervention. CONCLUSION:Reducing the dialysate temperature may be a feasible approach to alleviate post-dialysis fatigue without compromising thermal comfort.
Manufacturing variability can alter the hydraulic and hemocompatibility performance of a ventricular assist device (VAD) rotor even when the nominal design is computationally optimal. This study presents a surrogate-assisted robust-design workflow for a rotary VAD using a CFD-derived design-of-experiments database of 4809 rotor geometries defined by six input variables and seven performance outputs. Output-specific surrogate models were selected from linear regression, quadratic response-surface models, support-vector regression, random forests, gradient boosting, and multilayer perceptrons using five-fold cross-validated R2, yielding values from 0.7367 to 0.9966. The 16 best nominal designs were then propagated through 2500 surrogate-evaluated Monte Carlo realizations under four manufacturing-tolerance scenarios ranging from mild to extreme. Nominal ranking was based on the geometric mean of normalized desirability functions, whereas robust ranking combined scaled nominal desirability, feasibility probability, percentile-based desirability, and a degradation penalty. D1297 was the nominal optimum (D = 0.8125), but D717 became the preferred robust design under mild and moderate tolerances, with robust scores of 0.9031 and 0.8741, respectively. Under severe and extreme perturbations, D174 emerged as the leading candidate because it retained the best conservative percentile behavior and the smallest degradation while preserving full feasibility. Local sensitivity analysis identified clearance gap and rotor length as the dominant robustness drivers. The results show that production-oriented VAD design selection can differ materially from nominal optimization and that tolerance-aware ranking provides a surrogate-assisted computational screening basis for prioritizing rotor candidates before direct CFD confirmation, prototype fabrication, dimensional metrology, and experimental hemocompatibility testing.
OBJECTIVE:The pediatric patient group undergoing left ventricular assist device (LVAD) implantation is small and unique. Many efforts have been made to prolong survival. In our study, we aimed to evaluate the effects of levosimendan administration on postoperative outcomes in pediatric patients undergoing LVAD implantation. METHODS:This retrospective single-center study included patients under 18 years of age who underwent LVAD implantation. Patients with INTERMACS class 1 were excluded from the study. Patients were divided into two groups: Group A (n = 14), who received levosimendan preoperatively in addition to standard inotropic therapy, and Group B (n = 17), who received standard inotropic therapy alone. Levosimendan was administered at a dose of 0.1 µg/kg/min for 72 h without a loading bolus. Primary outcomes were early right ventricular failure and in-hospital mortality. Secondary outcomes included the need for right ventricular assist, late right ventricular failure, and changes in organ function as assessed by liver and kidney function tests. Safety points for drug administration were defined as arrhythmia, hypotension, and sudden arrest. RESULTS:Baseline characteristics (except LVEDD), ventricular function, and vasoactive inotropic scores were similar between the groups. No significant difference was observed in terms of early right ventricular failure, in-hospital mortality, or length of hospital stay. The rates of need for right ventricular assist and late right ventricular failure were comparable. Improvements in organ function were observed in both groups; significantly greater reductions in aspartate aminotransferase and alanine aminotransferase levels were recorded in the levosimendan group. No treatment-limiting side effects were observed. CONCLUSION:Preoperative levosimendan administration seems to be safe in pediatric LVAD candidates and is associated with improved end-organ function, although it has not demonstrated superiority over standard inotropic therapy in terms of preventing right ventricular failure or reducing mortality.
We report a serum BNP cut-off of 800 pg/mL above which all patients with LVAD HeartMate-3 had elevated biventricular filling pressures, suggesting it may be used to prompt invasive ramp study during routine post-LVAD clinic visit. We found stepwise increase in BNP levels across hemodynamic groups, with the lowest levels in patients with normal filling pressures, intermediate in those with elevated right or left-sided filling pressure and highest in those with elevated biventricular filling pressures. Furthermore, most patients with BNP above median value (335 pg/mL) required speed changes for either elevated right sided or left sided filling pressures. Conversely, patients with BNP below 335 pg/mL rarely required speed change. In conclusion, elevated serum BNP in patients with durable LVAD HeartMate-3 may have clinical value in prompting invasive hemodynamic assessment.
This study developed and evaluated a sodium alginate/hydroxyapatite/copper nanoparticle (SA/HA/CuNPs) putty implant for bone tissue engineering. The green-synthesized CuNPs product was characterized by UV-Vis, FTIR, XRD, and FESEM analyses. The putty implant exhibited a porous structure, enhanced biomineralization, antioxidant activity, and strong antibacterial effects against gram-positive (22.4 ± 1.2 mm) and gram-negative (19.8 ± 1.0 mm) bacteria. Mechanical testing showed tensile and compressive strengths of 8.6 ± 0.5 MPa and 14.2 ± 0.8 MPa, respectively. Cytocompatibility studies demonstrated >86% cell viability and favorable live/dead staining results. Overall, the SA/HA/CuNP implant showed promising potential for bone regeneration applications.
Fatigue is a common symptom in hemodialysis (HD) patients, and effective assessment is crucial for management. While there are various assessment tools, clinical consensus on their selection is lacking. Most reviews focus on the introduction of tools but overlook systematic evaluations of their psychometric properties, and there is limited focus on localization challenges in Chinese clinical practice. This review systematically evaluates the status of fatigue assessment tools for HD patients, their psychometric properties, and the needs for optimizing their application in Chinese localization. The system searched Chinese and English databases, including CNKI, Wanfang, Web of Science, PubMed, Embase, and CINAHL, from their inception to September 30, 2025, for literature on fatigue assessment tools for HD patients. A scoping review method was used for systematic summarization. A total of 38 articles were included, involving 13 fatigue assessment tools for HD patients, including 1 objective assessment tool and 12 subjective self-assessment scales, namely FSS, SF36-V, CFS, MFI-20, VAFS, FACIT-F, RPFS, BFI, PROMIS, PFS-12, PDF, and SONG-HD. These tools varied in dimensions, recall periods, adaptation status, and usage frequency. While some showed good reliability, most still lacked robust evidence for construct and cross-cultural validity. Clinically, tools should be chosen based on scenarios like screening, evaluation, or research. In China's HD field, fatigue assessment needs to transition from using borrowed tools to culturally adapted ones. Existing Chinese tools should be revalidated per international standards, and a core assessment system should be developed to align with the cultural and clinical context of Chinese patients.
A new principle has been developed that is orders of magnitude superior to the all main 3D bioprinters. Its specifications are comparable to the breakthrough Roll Porous Scaffold 3D bioprinting technology (cell density ~1.5 × 108 cell/mL, performance ~1.8 L/h, precision up to ~2500 DPI (~10 µm) for UV laser and submicron for Blu-ray one, but it is simpler. Substantial increase in the velocity of formation of solid organoid relative to conventional technique occurs due to the absence of pauses for the formation of scaffolds using stereolithography and extrusion. A new way based on prefabricated plates with two biodegradable lattice layers that dissolve quickly and slowly. The 1st mesh layer are designed to hold several cells, while the 2nd one act as a reinforcing base and filter, increasing the inkjet printing density with longer fill exposures for inkjet filling. The perimeter of the plates is made of incompressible material and controls the height of the layer of the formed bioobject when they are stacked.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become an accepted treatment modality for refractory cardiogenic shock (CS). However, its use is limited to tertiary centers due to resource allocation, education, and personnel requirements. The cannulate-and-ship model has therefore emerged to extend access to VA-ECMO. This model faces several communication, education, and logistical challenges. We describe the safety and early outcomes of a regional VA-ECMO training and air medical transport program that uses a text-message-based communication protocol and an "always open" VA-ECMO transfer status. In this retrospective descriptive study, 14 patients were cannulated at rural or limited-resource hospitals and transported by air to a tertiary ECMO center between October 2024 and December 2025. Median transport distance was 440 km. All patients survived transport without transport-related complications. Survival to VA-ECMO decannulation was 86%, to hospital discharge 79%, and 30-day survival from cannulation was 69%. These findings suggest that our structured regional program, incorporating simulation-based training, centralized consultation and communication, and perfusionist-supported transport, may safely extend VA-ECMO access to remote hospitals while addressing communication and logistical barriers.
BACKGROUND:Hemoperfusion has emerged as a potential extracorporeal blood purification strategy for attenuating inflammation during cardiopulmonary bypass (CPB), but perioperative biomarker trajectory data remain limited. This pilot comparative study evaluated whether integration of the HA380 cartridge into the CPB circuit was associated with altered postoperative inflammatory kinetics in adult cardiac surgery. METHODS:In this single-center, nonrandomized, biomarker-focused pilot study, 60 adult patients undergoing cardiac surgery with CPB were included, with 30 patients receiving HA380 hemoperfusion during CPB and 30 patients managed with conventional CPB alone. Serum levels of TNF-α, IL-1β, IL-6, IL-8, IL-10, and C-reactive protein (CRP) were measured at four standardized perioperative time points: T0 (preoperative baseline), T1 (end of surgery/ICU admission; 0 h), T2 (postoperative 24 h), and T3 (postoperative 48 h). Because treatment allocation was not randomized and baseline inflammatory imbalance was present, change-from-baseline and trajectory analyses were prioritized. RESULTS:The HA380 group entered surgery with a numerically higher baseline inflammatory burden. However, by postoperative 24 h and 48 h, most proinflammatory biomarkers in the HA380 group showed a downward trajectory or remained near baseline, whereas the control group demonstrated persistent postoperative elevation. This pattern was more clearly captured by change-from-baseline analyses than by crude postoperative absolute values alone. The composite inflammatory burden score decreased postoperatively in the HA380 group but increased progressively in the control group, supporting a global attenuation of inflammatory propagation rather than an isolated effect on a single cytokine. CONCLUSIONS:In this biomarker-focused pilot study, HA380 hemoperfusion integrated into the CPB circuit was associated with a more favorable postoperative inflammatory trajectory. These findings support the biologic plausibility of intraoperative hemoperfusion as an adjunct extracorporeal modulation strategy and justify further validation in larger studies.
BACKGROUND:Blood access is of outmost importance for haemodialysis treated patients. Access blood flow is the first determining factor conditioning blood volume, clearance and dialysis delivery. Access blood flow reduction may result in increased recirculation of the extracorporeal circuit and dialysis deficiency, and be indicative of a pre-thrombosis state. Modern dialysis monitors are equipped with automatic systems to determine recirculation. AIM:We aimed at assessing the reproducibility, reliability and sensitivity of recirculation ratio measurements during its use in clinics. METHODS:Forty-four unselected patients routinely treated with a monitor equipped with an ultrafiltration-based density modification to automatic assessment of recirculation were included in the study and two hundred and sixty-four dialysis procedures with over one thousand measurements of recirculation were analysed. RESULTS:The median recirculation ratio observed was 3% and interquartile range of 6. Only 4% of the measurements were between 10% and 15% and 6% were greater than 15%. The observed recirculation ratio values were consistent throughout the dialysis sessions and reproducible as 90% of sessions had a difference in maximum values up to 10%. CONCLUSIONS:Recirculation monitoring remains an important parameter to prevent both blood access complications and dialysis insufficiency. Recirculation measurements showed to be uneventful and provided relevant clinical information.
BACKGROUND:Hemolytic complications remain a major limitation of membrane oxygenators in clinical support. Compared with human lungs, most commercial oxygenators generate substantial pressure drops and high shear stress, increasing the risks of hemolysis. Therefore, we aimed to develop a membrane oxygenator that reduces pressure drop and shear-induced blood damage while maintaining the oxygen transfer rate. METHODS:We propose a parallel gas exchange chamber (PGEC) oxygenator in which the blood flow is divided into two identical gas exchange chambers connected in parallel. The computational fluid dynamics (CFD) model was used to design and analyze the oxygenators. The oxygen transfer rate and blood damage parameters of the PGEC and conventional oxygenator were evaluated by in vitro tests at a blood flow rate of 900 mL/min. Oxygen transfer rate, pressure drop, plasma free hemoglobin concentration, and thrombin-antithrombin complex (TAT) concentration were measured (n = 3). RESULTS:Under the present identical in vitro test conditions, the oxygen transfer rate of the PGEC oxygenator (18.15 ± 0.69 mL/min) was not significantly different from that of the conventional oxygenator (17.73 ± 0.73 mL/min). The PGEC design reduced pressure drop by 42% and decreased the normalized index of hemolysis (NIH) by 63% (p = 0.028), while TAT concentrations did not differ significantly between the two circuits. CONCLUSIONS:The parallel design of the gas exchange chambers decreases blood velocity in the hollow fiber membrane region, thereby lowering pressure drop and hemolysis while maintaining oxygen transfer rate under the tested conditions.
INTRODUCTION:Coronary artery calcification (CAC) is a predictor of poor survival and cardiovascular outcomes in patients with end-stage renal disease. This study assessed the risk factors for vascular calcification in patients on maintenance hemodialysis (HD). METHODS:In total, 71 patients who underwent HD in our hospital from January 2022 to September 2022 were enrolled. The general clinical data and laboratory results of the patients were collected and the CAC score was calculated. RESULTS:CAC occurred in 41/71 patients (57.75%) in the study. Baseline characteristics including primary disease, height, weight, blood pressure, dialysis duration, smoking history, and comorbid hypertension rates did not significantly differ between patients with and without CAC. Compared with the findings in the calcification group, the non-calcification group had significantly higher fibrinogen (4.2 (3.7-5.3) vs 3.6 (3.1-4.5); p = 0.01) and ferritin levels (194.0 (85.2-288.0) vs 44.9 (18.0-170.5); p < 0.01) and lower calcium levels (2.2 (2.0-2.3) vs 2.3 (2.2-2.4); p < 0.01) and red blood cell counts (3.0 ± 0.8 vs 3.4 ± 0.7; p < 0.01). In logistic regression analysis, the risk of CAC was predicted by diabetes (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.37-28.11; p = 0.02) and the red blood cell count (OR = 2.99, 95% CI = 1.05-5.02; p = 0.04). Based on receiver operating characteristic curve analysis, the area under the curve of the red blood cell count for predicting the risk of CAC was 0.66 (p = 0.02), using a clinical diagnostic cutoff of 2.99 (sensitivity, 75.6%; specificity, 56.7%). CONCLUSION:The incidence rate of CAC was high in patients on HD. Diabetes and elevated red blood cell count emerged as independent risk factors for predicting the risk of CAC in patients on HD.
INTRODUCTION:Large extracorporeal blood volume causes intradialytic hemodynamic instability. However, the impact of blood returning from the extracorporeal circuit on systemic tissue oxygenation after hemodialysis (HD) remains inadequately studied. METHODS:This single-center prospective observational study included 33 patients who underwent HD and clinical data from 81 HD sessions. Post-HD, blood is pumped at a rate of 120 mL/min for 3 min as the extracorporeal circuit is rinsed. Cerebral and hepatic regional oxygenation saturation (rSO2) levels were monitored from the end of HD to 5 min post-HD. RESULTS:There were significant increases in cerebral and hepatic rSO2 levels at 5 min post-HD compared with those post-HD (cerebral rSO2; 52.6 ± 7.3 vs 54.2 ± 7.1, hepatic rSO2; 63.0% ± 10.9% vs 68.8% ± 10.3%, p < 0.001, respectively). %Changes in hepatic rSO2 at 5 min post-HD were significantly greater than those in cerebral rSO2 (3.4% ± 5.7% vs 9.9% ± 6.7%, p < 0.001) and were independently and significantly associated with ultrafiltration rate (standardized coefficient: 0.217), mean blood pressure post-HD (-0.374), and oxygen saturation post-HD (0.258). CONCLUSIONS:We demonstrated that the impact of blood returning post-HD on changes in tissue oxygenation may have been greater in the liver than in the brain.
PURPOSE:Durable LVAD therapy improves survival for advanced heart failure, yet adverse outcomes remain common. We evaluated whether combining pre-implant echocardiography with routinely available Electronic Health Record (EHR) data yields clinically useful post-LVAD risk predictions to improve patient selection and perioperative management. METHODS:In this retrospective study (2015-2022), pre-implant apical four-chamber echocardiograms were processed via raw loops and U-Net segmentation. CNN embeddings were integrated with PCA-reduced EHR variables including demographics, laboratories, and hemodynamics. Survival models, including Cox proportional hazards and random survival forests, were trained on multimodal inputs. Performance was validated using stratified 5-fold cross-validation, targeting a primary endpoint of time to death or missed follow-up. Saliency mapping was utilized to ensure clinical interpretability of the model's features. RESULTS:Multimodal models achieved higher discrimination than single-modality models, with segmented-echo inputs outperforming raw videos (mean C-index of 0.711). Saliency mapping identified clinically coherent predictors: right ventricular and septal geometry on imaging, alongside renal, hepatic, and nutritional status from the EHR. CONCLUSIONS:Integrating pre-implant echocardiography with EHR data enhances risk stratification survival for LVAD candidates. This multimodal approach identifies high-risk phenotypes, specifically right-heart and systemic frailty, providing a framework for personalized clinical decision support and future multicenter validation.
BACKGROUND:Peritoneal dialysis-related peritonitis (PDRP) remains a significant cause of technical failure and mortality. Hematologic inflammatory indices (HIIs) have previously been associated with the incidence of peritonitis and long-term outcomes in peritoneal dialysis. Their prognostic usefulness in acute PDRP remains unclear. This study evaluated the relationship between HIIs and clinical outcomes in acute PDRP. METHODS:This retrospective single-center study included 114 PDRP episodes recorded between 2012 and 2024. Baseline biochemical parameters and HIIs (NLR, PLR, MLR, NPAR, PIV) were collected at diagnosis. Clinical outcomes included treatment response, catheter removal, transition to hemodialysis, mortality and length of hospital stay. Correlation analyses, receiver operating characteristic (ROC) curves, and univariate and multivariable logistic regression analyses were performed. RESULTS:Treatment response occurred in 71.9% of episodes and peritonitis-related mortality was 10.5%. HIIs showed weak correlations with dialysate leukocyte count at diagnosis (r = 0.210-0.369) and were not associated with treatment response or mortality (all p > 0.05). Lower serum creatinine and parathyroid hormone (PTH) levels were independently associated with poor treatment response (creatinine (OR 2.43, 95% CI 1.00-5.91); PTH (OR 2.99, 95% CI 1.24-7.24)). For mortality, lower phosphate, creatinine, urea and LDL-C levels were significant in univariate analysis. ROC analysis demonstrated moderate discrimination (AUC range: 0.698-0.729). In multivariable analysis, low urea (OR 5.91, 95% CI 1.34-26.08), low creatinine (OR 6.07, 95% CI 1.35-27.20), and low LDL-C (OR 4.82, 95% CI 1.15-20.24) remained independently associated with mortality. CONCLUSION:HIIs were not associated with clinical outcomes in PDRP. In contrast, lower creatinine and PTH levels were independently associated with treatment non-response, while lower urea, creatinine and LDL-C levels were independently associated with peritonitis-related mortality, suggesting that underlying nutritional and metabolic status may influence clinical outcomes.
BACKGROUND:Many patients requiring VA-ECMO for acute coronary syndromes receive P2Y12 inhibitor therapy to prevent stent thrombosis, yet existing literature reports only composite bleeding rates without stratification by anatomic site. Whether P2Y12 inhibitor use produces distinct bleeding patterns compared to standard heparin anticoagulation remains underexplored. METHODS:Retrospective analysis of adult VA-ECMO patients at NewYork-Presbyterian Hospital (April 2011-January 2025). Patients receiving P2Y12 inhibitors plus heparin (n = 36) were compared to those receiving standard heparin alone (n = 129). Postcardiotomy patients were excluded. Primary outcomes were site-specific bleeding complications. Multivariate logistic regression adjusted for baseline differences in illness severity. RESULTS:P2Y12 patients were older (63.0 vs 50.7 years, p < 0.001), had higher rates of cardiac arrest (83.3% vs 55.0%, p = 0.002), and elevated lactate (10.2 vs 7.1 mmol/L, p = 0.004). P2Y12 inhibitor use was associated with increased airway hemorrhage (19.4% vs 7.0%, p = 0.049) and reduced weaning success (44.4% vs 66.7%, p = 0.015). On multivariate analysis adjusting for illness severity, P2Y12 inhibitor use was not associated with bleeding complications or mortality, whereas lactate was an independent predictor of mortality (OR 1.11 per mmol/L, 95% CI 1.02-1.20, p = 0.020). CONCLUSIONS:Although not independently associated with bleeding complications, P2Y12 inhibitor therapy in VA-ECMO patients identifies a high-risk population with elevated airway hemorrhage. These findings support enhanced mucosal surveillance and individualized anticoagulation strategies in this vulnerable population.
