整合文献计量学分析与SAVE评分在VA-ECMO治疗难治性心源性休克中的外部验证：来自全球趋势和MIMIC-IV数据库的见解

摘要(中文译文)

体外膜氧合（ECMO）是难治性心源性休克患者的关键干预措施，但其管理复杂，并伴随血栓栓塞、出血和感染等重大风险。本研究旨在全面概述全球研究趋势，并评估现有预后工具的临床实用性。在Web of Science核心合集上进行了1988年至2024年的文献检索。采用文献计量学工具VOSviewer 1.6.20、CiteSpace 6.3.R1和R 4.3.3对合作网络、关键词共现和新兴研究趋势进行可视化。此外，从重症监护医学信息库IV（MIMIC-IV）（v2.2）数据库中识别了一个接受静脉-动脉体外膜氧合（VA-ECMO）的成人难治性心源性休克患者的回顾性队列。在该队列中对静脉-动脉ECMO后生存（SAVE）评分的区分度和校准度进行了外部验证。文献计量学分析显示，美国在发文量上领先[129篇]，其次是法国[96篇]和中国[72篇]，巴黎公共援助医院（APHP）和法国国家健康与医学研究院（INSERM）为关键机构。主要期刊包括、、和，主要作者为Alain Combes、Pascal Leprince和Guillaume Lebreton。自2020年以来，研究热点已转向“心室辅助装置”、“指南”和“院内心脏骤停”。在MIMIC-IV验证队列（n=101）中，SAVE评分在预测VA-ECMO患者院内死亡率方面表现出有限的区分度[受试者工作特征曲线下面积（AUC-ROC）0.578]和显著的校准不良。决策曲线分析表明净临床获益极小，凸显了外部验证和模型适配对真实世界实践的重要性。本研究强调了现有预后工具在不同临床环境中的性能差异，提示SAVE评分等工具在应用于局部队列时需谨慎解读。未来心源性休克的ECMO研究必须完善管理策略、标准化指南，并通过严格的多中心外部验证改进预测模型。利用MIMIC-IV等大型临床数据库对于推进精准医学和优化这一高危人群的结局至关重要。

Abstract

Extracorporeal membrane oxygenation (ECMO) is a crucial intervention for patients with refractory cardiogenic shock, though its management is complex and carries substantial risks such as thromboembolism, hemorrhage, and infection. This study aims to provide a comprehensive overview of global research trends and to assess the clinical utility of established prognostic tools. A literature search was conducted on the Web of Science Core Collection from 1988 to 2024. The bibliometric tools VOSviewer 1.6.20, CiteSpace 6.3.R1, and the R 4.3.3 were employed to visualize collaboration networks, keyword co-occurrences, and emerging research trends. Additionally, a retrospective cohort of adult patients with refractory cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) (v2.2) database. The Survival After Veno-Arterial ECMO (SAVE) score's discrimination and calibration were externally validated in this cohort. The bibliometric analysis showed that the USA led in publications [129], followed by France [96] and China [72], with Assistance Publique Hôpitaux Paris (APHP) and Institut National de la Santé et de la Recherche Médicale (INSERM) among key institutions. Major journals included , , and , and leading authors were Alain Combes, Pascal Leprince, and Guillaume Lebreton. Since 2020, research hotspots have shifted toward "ventricular assist device", "guidelines", and "hospital cardiac arrest". In the MIMIC-IV validation cohort (n=101), the SAVE score demonstrated limited discrimination [area under the receiver operating characteristic curve (AUC-ROC) 0.578] and significant miscalibration for predicting in-hospital mortality among VA-ECMO patients. Decision curve analysis indicated minimal net clinical benefit, underscoring the importance of external validation and model adaptation for real-world practice. This study underscores the performance variations of established prognostic tools across different clinical settings, suggesting that tools like the SAVE score require cautious interpretation when applied to localized cohorts. Future ECMO research in cardiogenic shock must refine management strategies, standardize guidelines, and improve prediction models through rigorous multi-center external validation. Leveraging large clinical databases such as MIMIC-IV will be essential for advancing precision medicine and optimizing outcomes in this high-risk population.

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