Abstract
BACKGROUND: Venoarterial extracorporeal membrane oxygenation induces an inflammatory response upon initiation. The neutrophil percentage-to-albumin ratio is a promising biomarker for predicting mortality in patients with systemic inflammation. This study aimed to investigate the association between neutrophil percentage-to-albumin ratio and in-hospital mortality in pediatric patients with acute fulminant myocarditis undergoing extracorporeal membrane oxygenation and to develop a PEACE model for predicting mortality in these patients. METHODS: This retrospective study included pediatric patients diagnosed with acute fulminant myocarditis who underwent venoarterial extracorporeal membrane oxygenation between July 2015 and August 2022. Multivariable logistic regression analysis was used to investigate the independent association between the neutrophil percentage-to-albumin ratio and the risk of in-hospital mortality. In addition, we utilized least absolute shrinkage and selection operator regression to select predictive factors, ultimately developing a nomogram to predict outcomes in pediatric patients receiving venoarterial extracorporeal membrane oxygenation. RESULTS: A total of 125 patients eligible for analysis were included in this study, with an in-hospital mortality rate of 28.8%. Multivariable logistic regression revealed that the neutrophil percentage-to-albumin ratio was an independent risk factor for in-hospital mortality in venoarterial extracorporeal membrane oxygenation patients. Restricted cubic splines revealed a positive association between the two (P(nonlinearity) = 0.84). Least absolute shrinkage and selection operator regression and backward stepwise logistic regression identified age, cardiopulmonary resuscitation, lactate levels, and the neutrophil percentage-to-albumin ratio as key predictive factors. Using these factors, a nomogram (PEACE model) was developed to predict in-hospital mortality in venoarterial extracorporeal membrane oxygenation patients. The area under the receiver operating characteristic curve was 0.83 [95% confidence interval (CI), 0.74-0.92], with the inclusion of the neutrophil percentage-to-albumin ratio significantly enhancing the model's predictive accuracy. CONCLUSIONS: The neutrophil percentage-to-albumin ratio may serve as a potential predictor for venoarterial extracorporeal membrane oxygenation in-hospital mortality in pediatric patients with acute fulminant myocarditis, suggesting that inflammatory responses are associated with patient prognosis. The PEACE model is superior in predicting the prognosis of pediatric patients supported by venoarterial extracorporeal membrane oxygenation, and can help in clinical decision making.