{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:59:06Z","timestamp":1781647146065,"version":"3.54.5"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Hochschule Hannover (MHH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Bleeding complications during venovenous extracorporeal membrane oxygenation (ECMO) remain a leading cause of morbidity, yet granular longitudinal data linking daily biomarker dynamics to bleeding around circuit exchanges are scarce. We analyzed 93 exchanges from 35 severe acute respiratory distress syndrome (ARDS) patients (2020\u20132022) across 15-day peri-exchange windows in this retrospective single-center cohort study. Major bleeding (defined by ELSO criteria) occurred on 100\/1317 observation-days (7.6%), clustering peri-exchange (13.1% vs. 4.2% outside \u00b1\u20092 days,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Using generalized linear mixed models (GLMMs) with nested random effects, we characterized coagulation trajectories and bleeding predictors. White blood cell count was the strongest predictor (OR 2.00\/SD, 95% CI 1.43\u20132.82,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), followed by platelets (OR 0.58,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.014) and fibrinogen (OR 0.60,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.035). Time-lagged GLMMs identified D-dimer and fibrinogen as early warning markers 1\u20132 days pre-bleeding. Circuit exchange shortened bleeding duration (HR 2.23, 95% CI 1.16\u20134.29,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.017). D-dimer rose pre-exchange and declined post-exchange, while fibrinogen and platelets showed inverse patterns, suggesting consumptive coagulopathy reversed by exchange. White blood cell trajectories implicated independent inflammatory risk. These findings demonstrate a 1\u20132 days predictive time window for any action needed to counteract or prevent major bleeding, supporting biomarker-guided circuit management and hemostatic strategies in ECMO.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-47560-0","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:28:01Z","timestamp":1775723281000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Daily biomarker trajectories predict major bleeding in patients on venovenous ECMO for ARDS: a retrospective longitudinal cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Thomas","family":"Stueber","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jil-Madeline","family":"Homeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Joerg","family":"Gillmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jona","family":"Wassong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"47560_CR1","doi-asserted-by":"publisher","first-page":"2048","DOI":"10.1007\/s00134-020-06248-3","volume":"46","author":"A Combes","year":"2020","unstructured":"Combes, A. et al. ECMO for severe ARDS: Systematic review and individual patient data meta-analysis. Intensive Care Med. 46, 2048\u20132057. https:\/\/doi.org\/10.1007\/s00134-020-06248-3 (2020).","journal-title":"Intensive Care Med."},{"key":"47560_CR2","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1164\/rccm.202305-0896OC","volume":"209","author":"G Martucci","year":"2024","unstructured":"Martucci, G. et al. Anticoagulation and bleeding during veno-venous extracorporeal membrane oxygenation: Insights from the PROTECMO study. Am. J. Respir Crit. Care Med. 209, 417\u2013426. https:\/\/doi.org\/10.1164\/rccm.202305-0896OC (2024).","journal-title":"Am. J. Respir Crit. Care Med."},{"key":"47560_CR3","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1007\/s00134-022-06794-y","volume":"48","author":"A Mansour","year":"2022","unstructured":"Mansour, A. et al. Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: A nationwide cohort study. Intensive Care Med. 48, 1039\u20131052. https:\/\/doi.org\/10.1007\/s00134-022-06794-y (2022).","journal-title":"Intensive Care Med."},{"key":"47560_CR4","doi-asserted-by":"publisher","first-page":"1530411","DOI":"10.3389\/fmed.2025.1530411","volume":"12","author":"C Jung","year":"2025","unstructured":"Jung, C., Stueber, T., Mirus, M., Heubner, L. & Spieth, P. M. Anticoagulation in venovenous extracorporeal membrane oxygenation. Front. Med. 12, 1530411. https:\/\/doi.org\/10.3389\/fmed.2025.1530411 (2025).","journal-title":"Front. Med."},{"key":"47560_CR5","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1007\/s00134-023-07224-3","volume":"49","author":"J Helms","year":"2023","unstructured":"Helms, J., Curtiaud, A., Severac, F., Merdji, H. & Angles-Cano, E. 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The study was conducted in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12041"}}