Hemolysis Index, Carboxyhemoglobin, and Methemoglobin for the Early Identification of Patients at Risk for Cardiac Surgery-Associated Acute Kidney Injury.

Autor: Golinvaux E; Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France., Goronflot T; Pôle Hospitalo-Universitaire 11, Santé Publique, Clinique des données, Nantes Université, CHU Nantes, INSERM CIC 1413, Nantes, France., Cadiet J; Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France., Senage T; Service de Chirurgie Cardiaque, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France; INSERM 1246, Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation (SPHERE) unit, Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France., Rozec B; Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France; Institut du Thorax, INSERM, CNRS, Université de Nantes, Nantes, France., Boissier E; Laboratoire d'Hématologie, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France., Bigot-Corbel E; Laboratoire de Biochimie, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France., Lakhal K; Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France. Electronic address: lakhal_karim@yahoo.fr.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Dec; Vol. 38 (12), pp. 3086-3093. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.1053/j.jvca.2024.09.143
Abstrakt: Objectives: Hemolysis is a contributor to CS-AKI. Biochemistry analyzers provide a hemolysis index to quantify in vitro hemolysis, a condition that can, for example, affect the accuracy of potassium concentration measurements. We aimed to assess whether the postoperative plasma level of the hemolysis index (HI postoperative ) could aid the early recognition of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) and also to evaluate other hemolysis indicators: plasma carboxyhemoglobin (COHb postoperative ) and methemoglobin (MetHb postoperative ).
Design: One-year retrospective study.
Setting: University hospital.
Participants: Patients undergoing elective cardiac surgery.
Interventions: None.
Measurements and Main Results: In 1090 patients, the median HI postoperative was higher in patients who developed CS-AKI compared to patients who did not (11 mg/dL [interquartile range (IQR), 5-38 mg/dL] v 7 mg/dL [IQR, 3-16 mg/dL]; p < 0.001). HI postoperative refined the early recognition of CS-AKI: the area under the precision-recall curve (AUPRC) for HI postoperative was 37% (95% confidence interval [CI], 31%-42%), whereas the AUPRC associated with no discriminative power, equal to the prevalence of CS-AKI in the whole population, was 21%. Among the 611 patients with measurements for all 3 biomarkers, the AUPRC of HI postoperative was higher than that of COHb postoperative or MetHb postoperative (+6.6% and +7.4% respectively; p < 0.0001 for both). Unlike COHb postoperative or MetHb postoperative , the incorporation of HI postoperative into a model (trained on a sample then validated in another sample) of CS-AKI early recognition significantly enhanced its performance, with a +1.9% (95% CI, 1.6%-2.1%) increase in AUPRC (p < 0.0001).
Conclusions: Elevated HI postoperative represents an early alert signal for the development of CS-AKI. Our findings support the incorporation of HI postoperative , a readily available biomarker, into predictive scores of CS-AKI.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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