Early Pan-Immune-Inflammation Value Trajectories are Associated with Unfavorable Neurological Outcomes After Extracorporeal Cardiopulmonary Resuscitation
- 1Department of Geriatrics
- 2Department of Emergency
- 3Department of Critical Care Medicine
Abstract
Man Wang,1,2 Ying Zhang,2 Lifang Lu,1 Zhenhe Mo,2 Zhongyi Sun3,41Department of Geriatrics, Guigang City People’ s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, 537100, People’s Republic of China; 2Department of Emergency, Guigang City People’ s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, 537100, People’s Republic of China; 3Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China; 4Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, 430071, People’s Republic of ChinaCorrespondence: Man Wang, Email [email protected] Zhongyi Sun, Email [email protected]: Neurological outcome is key to extracorporeal cardiopulmonary resuscitation (ECPR) benefit. However, the prognostic relevance of early PIV dynamics after ECPR remains poorly characterized.Methods: We conducted an exploratory retrospective single-center study of 107 ECPR patients with at least three valid complete blood count (CBC) measurements within 24 h of extracorporeal membrane oxygenation (ECMO) pump-on. The primary outcome was an unfavorable neurological outcome at hospital discharge, defined as Cerebral Performance Category (CPC) 3– 5. Latent class mixed models (LCMMs) were used to identify early pan-immune-inflammation value (PIV) trajectory groups, and multivariable logistic regression evaluated their association with the outcome. Incremental predictive performance was explored using leakage-controlled nested cross-validation in which trajectory modeling was repeated within each outer training fold.Results: Among 107 included patients, 53 had an unfavorable neurological outcome at hospital discharge. Two distinct early PIV trajectory patterns were identified in this selected cohort: a high-baseline decreasing class (n=68) and a low-baseline rising class (n=39). The low-baseline rising class had a significantly higher rate of unfavorable neurological outcome than the high-baseline decreasing class (69.2% vs 38.2%, P=0.004). In the fully adjusted model, the low-baseline rising trajectory was associated with significantly higher odds of unfavorable neurological outcome compared with the high-baseline decreasing trajectory (odds ratio 5.70, 95% confidence interval 1.73– 18.81, P=0.004). In an internal exploratory comparison, adding the trajectory class to the clinical risk model increased the area under the receiver operating characteristic curve from 0.746 to 0.812, but the bootstrap 95% CI for the AUC increment crossed zero.Conclusion: Two exploratory early PIV trajectory groups were identified in this selected cohort. The low-baseline rising pattern was associated with a higher probability of CPC-defined unfavorable neurological outcome at hospital discharge in this selected single-center cohort. Although trajectory information numerically improved internal predictive performance, the incremental improvement was uncertain and requires external validation.Keywords: extracorporeal cardiopulmonary resuscitation, pan-immune-inflammation value, trajectory analysis, neurological outcome, latent class mixed model, inflammatory biomarkers
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BibTeX
@article{wang2026early,
title = {{Early Pan-Immune-Inflammation Value Trajectories are Associated with Unfavorable Neurological Outcomes After Extracorporeal Cardiopulmonary Resuscitation}},
author = {Wang M and Zhang Y and Lu L and Mo Z and Sun Z},
journal = {Journal of Inflammation Research},
year = {2026},
month = oct,
url = {https://www.dovepress.com/early-pan-immune-inflammation-value-trajectories-are-associated-with-u-peer-reviewed-fulltext-article-JIR},
note = {CC BY},
}
RIS
TY - JOUR
TI - Early Pan-Immune-Inflammation Value Trajectories are Associated with Unfavorable Neurological Outcomes After Extracorporeal Cardiopulmonary Resuscitation
AU - Wang M
AU - Zhang Y
AU - Lu L
AU - Mo Z
AU - Sun Z
PY - 2026
DA - 2026/10/01
JO - Journal of Inflammation Research
UR - https://www.dovepress.com/early-pan-immune-inflammation-value-trajectories-are-associated-with-u-peer-reviewed-fulltext-article-JIR
AB - Man Wang,1,2 Ying Zhang,2 Lifang Lu,1 Zhenhe Mo,2 Zhongyi Sun3,41Department of Geriatrics, Guigang City People’ s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, 537100, People’s Republic of China; 2Department of Emergency, Guigang City People’ s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, 537100, People’s Republic of China; 3Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China; 4Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, 430071, People’s Republic of ChinaCorrespondence: Man Wang, Email [email protected] Zhongyi Sun, Email [email protected]: Neurological outcome is key to extracorporeal cardiopulmonary resuscitation (ECPR) benefit. However, the prognostic relevance of early PIV dynamics after ECPR remains poorly characterized.Methods: We conducted an exploratory retrospective single-center study of 107 ECPR patients with at least three valid complete blood count (CBC) measurements within 24 h of extracorporeal membrane oxygenation (ECMO) pump-on. The primary outcome was an unfavorable neurological outcome at hospital discharge, defined as Cerebral Performance Category (CPC) 3– 5. Latent class mixed models (LCMMs) were used to identify early pan-immune-inflammation value (PIV) trajectory groups, and multivariable logistic regression evaluated their association with the outcome. Incremental predictive performance was explored using leakage-controlled nested cross-validation in which trajectory modeling was repeated within each outer training fold.Results: Among 107 included patients, 53 had an unfavorable neurological outcome at hospital discharge. Two distinct early PIV trajectory patterns were identified in this selected cohort: a high-baseline decreasing class (n=68) and a low-baseline rising class (n=39). The low-baseline rising class had a significantly higher rate of unfavorable neurological outcome than the high-baseline decreasing class (69.2% vs 38.2%, P=0.004). In the fully adjusted model, the low-baseline rising trajectory was associated with significantly higher odds of unfavorable neurological outcome compared with the high-baseline decreasing trajectory (odds ratio 5.70, 95% confidence interval 1.73– 18.81, P=0.004). In an internal exploratory comparison, adding the trajectory class to the clinical risk model increased the area under the receiver operating characteristic curve from 0.746 to 0.812, but the bootstrap 95% CI for the AUC increment crossed zero.Conclusion: Two exploratory early PIV trajectory groups were identified in this selected cohort. The low-baseline rising pattern was associated with a higher probability of CPC-defined unfavorable neurological outcome at hospital discharge in this selected single-center cohort. Although trajectory information numerically improved internal predictive performance, the incremental improvement was uncertain and requires external validation.Keywords: extracorporeal cardiopulmonary resuscitation, pan-immune-inflammation value, trajectory analysis, neurological outcome, latent class mixed model, inflammatory biomarkers
SN - 1178-7031
ER -