Jill M Cholette1, Anthony P Pietropaoli2, Kelly F Henrichs3, George M Alfieris4, Karen S Powers1, Francisco Gensini4, Jeffrey S Rubenstein1, Dawn Sweeney5, Richard Phipps3,6, Sherry L Spinelli3, Majed A Refaai2,3, Michael P Eaton5, Neil Blumberg3. 1. Department of Pediatrics, University of Rochester Medical Center, Rochester, New York. 2. Department of Medicine, University of Rochester Medical Center, Rochester, New York. 3. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York. 4. Department of Surgery, University of Rochester Medical Center, Rochester, New York. 5. Department of Anesthesiology, University of Rochester Medical Center, Rochester, New York. 6. Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York.
Abstract
BACKGROUND: There are data suggesting that free hemoglobin (Hb), heme, and iron contribute to infection, thrombosis, multiorgan failure, and death in critically ill patients. These outcomes may be mitigated by haptoglobin. STUDY DESIGN AND METHODS: 164 consecutively treated children undergoing surgery for congenital heart disease were evaluated for associations between free Hb and haptoglobin and clinical outcomes, physiologic metrics, and biomarkers of inflammation RESULTS: Higher perioperative free Hb levels (and lower haptoglobin levels) were associated with mortality, nosocomial infection, thrombosis, hours of intubation and inotropes, increased interleukin-6, peak serum lactate levels, and lower nadir mean arterial pressures. The median free Hb in patients without infection (30 mg/dL; 29 interquartile range [IQR], 24-52 mg/dL) was lower than in those who became infected (39 mg/dL; IQR, 33-88 mg/ 31 dL; p = 0.0046). The median mechanical ventilation requirements were 19 (IQR, 7-72) hours in patients with higher levels of haptoglobin versus 48 (IQR, 18-144) hours in patients with lower levels (p = 0.0047). Transfusion dose, bypass duration, and complexity of surgery were all significantly correlated with Hb levels and haptoglobin levels. Multivariate analyses demonstrated that these variables were independently and significantly associated with outcomes. CONCLUSIONS: Elevated pre- and postoperative levels of free Hb and decreased levels of haptoglobin were associated with adverse clinical outcomes, inflammation, and unfavorable physiologic metrics. Transfusion, RACHS score, and duration of bypass were associated with increased free Hb and decreased haptoglobin. Further investigation of the role of hemolysis and haptoglobin as potential mediators or markers of outcomes is warranted.
BACKGROUND: There are data suggesting that free hemoglobin (Hb), heme, and iron contribute to infection, thrombosis, multiorgan failure, and death in critically illpatients. These outcomes may be mitigated by haptoglobin. STUDY DESIGN AND METHODS: 164 consecutively treated children undergoing surgery for congenital heart disease were evaluated for associations between free Hb and haptoglobin and clinical outcomes, physiologic metrics, and biomarkers of inflammation RESULTS: Higher perioperative free Hb levels (and lower haptoglobin levels) were associated with mortality, nosocomial infection, thrombosis, hours of intubation and inotropes, increased interleukin-6, peak serum lactate levels, and lower nadir mean arterial pressures. The median free Hb in patients without infection (30 mg/dL; 29 interquartile range [IQR], 24-52 mg/dL) was lower than in those who became infected (39 mg/dL; IQR, 33-88 mg/ 31 dL; p = 0.0046). The median mechanical ventilation requirements were 19 (IQR, 7-72) hours in patients with higher levels of haptoglobin versus 48 (IQR, 18-144) hours in patients with lower levels (p = 0.0047). Transfusion dose, bypass duration, and complexity of surgery were all significantly correlated with Hb levels and haptoglobin levels. Multivariate analyses demonstrated that these variables were independently and significantly associated with outcomes. CONCLUSIONS: Elevated pre- and postoperative levels of free Hb and decreased levels of haptoglobin were associated with adverse clinical outcomes, inflammation, and unfavorable physiologic metrics. Transfusion, RACHS score, and duration of bypass were associated with increased free Hb and decreased haptoglobin. Further investigation of the role of hemolysis and haptoglobin as potential mediators or markers of outcomes is warranted.
Authors: Jill M Cholette; Kelly F Henrichs; George M Alfieris; Karen S Powers; Richard Phipps; Sherry L Spinelli; Michael Swartz; Francisco Gensini; L Eugene Daugherty; Emily Nazarian; Jeffrey S Rubenstein; Dawn Sweeney; Michael Eaton; Norma B Lerner; Neil Blumberg Journal: Pediatr Crit Care Med Date: 2012-05 Impact factor: 3.624
Authors: Camilla L'Acqua; Sheila Bandyopadhyay; Richard O Francis; Donald J McMahon; Marianne Nellis; Sujit Sheth; Steven G Kernie; Gary M Brittenham; Steven L Spitalnik; Eldad A Hod Journal: Am J Hematol Date: 2015-10 Impact factor: 10.047
Authors: Jill M Cholette; Anthony P Pietropaoli; Kelly F Henrichs; George M Alfieris; Karen S Powers; Richard Phipps; Sherry L Spinelli; Michael Swartz; Francisco Gensini; L Eugene Daugherty; Emily Nazarian; Jeffrey S Rubenstein; Dawn Sweeney; Michael Eaton; Neil Blumberg Journal: Pediatr Crit Care Med Date: 2015-03 Impact factor: 3.624
Authors: Francesca Rapido; Gary M Brittenham; Sheila Bandyopadhyay; Francesca La Carpia; Camilla L'Acqua; Donald J McMahon; Abdelhadi Rebbaa; Boguslaw S Wojczyk; Jane Netterwald; Hangli Wang; Joseph Schwartz; Andrew Eisenberger; Mark Soffing; Randy Yeh; Chaitanya Divgi; Yelena Z Ginzburg; Beth H Shaz; Sujit Sheth; Richard O Francis; Steven L Spitalnik; Eldad A Hod Journal: J Clin Invest Date: 2016-12-12 Impact factor: 14.808
Authors: Francesca Vinchi; Milene Costa da Silva; Giada Ingoglia; Sara Petrillo; Nathan Brinkman; Adrian Zuercher; Adelheid Cerwenka; Emanuela Tolosano; Martina U Muckenthaler Journal: Blood Date: 2015-12-16 Impact factor: 22.113
Authors: Anthony P Pietropaoli; Kelly F Henrichs; Jill M Cholette; Sherry L Spinelli; Richard P Phipps; Majed A Refaai; Neil Blumberg Journal: Transfusion Date: 2019-02-27 Impact factor: 3.157