Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study.
Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study.
复制标题
DOI：
10.1097/ccm.0b013e3182741a54
复制
发表时间：
2013-03
影响因子：
8.8
通讯作者：
Ware LB
中科院分区：
文献类型：
--
作者：
Janz DR;Bastarache JA;Peterson JF;Sills G;Wickersham N;May AK;Roberts LJ 2nd;Ware LB
确定败血症患者循环无细胞血红蛋白与不良临床结局的相关性，并描述对乙酰氨基酚（一种血红蛋白介导的氧化抑制剂）的潜在保护作用。回顾性观察研究。在一家学术性三级保健医院的多个重症监护病房中，共有391名败血症危重患者。没有。与存活者（10 mg/dl，IQR 10-30，p = 0.002）相比，非存活者在入组时测量的血浆无细胞血红蛋白浓度（中位数20 mg/dl，IQR 10-40）显著更高。在控制了潜在的混杂因素后，无细胞血红蛋白浓度较高的患者在医院死亡的可能性显著更高（OR 1.078，95% CI 1.012-1.149，p = 0.02）。此外，在无细胞血红蛋白增加的情况下接受对乙酰氨基酚与死亡保护作用独立相关（OR 0.48，95% CI 0.25-0.91，p = 0.026）和较低的脂质过氧化产物F2-异前列腺素血浆浓度（18.5 pg/ml IQR 9-22.2）与无对乙酰氨基酚（42 pg/ml，IQR 29.7-86，p = 0.009）相比。在脓毒症危重患者中，循环无细胞血红蛋白浓度升高与死亡风险增加独立相关。对乙酰氨基酚可能通过减少无细胞血红蛋白诱导的氧化损伤发挥保护作用。
To determine the association of circulating cell-free hemoglobin with poor clinical outcomes in patients with sepsis and to characterize the potential protective effects of acetaminophen, an inhibitor of hemoprotein-mediated oxidation. Retrospective observational study. A total of 391 critically ill patients with sepsis in multiple intensive care units in an academic tertiary care hospital. None. Nonsurvivors had significantly higher plasma cell-free hemoglobin concentrations (median 20 mg/dl, IQR 10–40) measured on enrollment compared to survivors (10 mg/dl, IQR 10–30, p = 0.002). After controlling for potential confounders, patients with higher cell-free hemoglobin concentrations were significantly more likely to die in the hospital (OR 1.078, 95% CI 1.012–1.149, p = 0.02). In addition, receiving acetaminophen in the setting of increased cell-free hemoglobin was independently associated with a protective effect against death (OR 0.48, 95% CI 0.25–0.91, p = 0.026) and lower plasma concentrations of the lipid peroxidation product F2-isoprostanes (18.5 pg/ml IQR 9–22.2) compared to no acetaminophen (42 pg/ml, IQR 29.7–86, p = 0.009). In critically ill patients with sepsis, elevated concentrations of circulating cell-free hemoglobin are independently associated with an increased risk of death. Acetaminophen may exert a protective effect by reducing cell-free hemoglobin-induced induced oxidative injury.