Free hemoglobin concentration in severe sepsis: methods of measurement and prediction of outcome.
Free hemoglobin concentration in severe sepsis: methods of measurement and prediction of outcome.
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DOI：
10.1186/cc11425
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发表时间：
2012-07-16
期刊：
影响因子：
--
通讯作者：
Hartmann M
中科院分区：
文献类型：
--
作者：
Adamzik M;Hamburger T;Petrat F;Peters J;de Groot H;Hartmann M
脓毒症可通过多种机制诱导溶血，其病理生理学意义已在实验性脓毒症中得到证实。然而，没有关于人败血症中游离血红蛋白浓度的数据。在本研究中，我们使用四种方法测量了严重脓毒症患者和术后患者的游离血红蛋白。我们的目的是确定游离血红蛋白作为危重病中严重脓毒症诊断和预后的生物标志物的潜在价值。在诊断和手术的第1天测定严重脓毒症患者（n = 161）和术后患者（n = 136）的血浆游离血红蛋白浓度。对于游离血红蛋白的测量，使用酶联免疫吸附测定法和三种分光光度算法。此外，SAPS II和SOFA评分以及降钙素原浓度和结果进行了测定。进行Kaplan-Meier分析，根据中位数将游离血红蛋白浓度分为高浓度组和低浓度组后确定比值比。使用Mann-Whitney检验和逻辑回归分析进行统计学评价。在严重脓毒症的非幸存者中，游离血红蛋白浓度是幸存者的两倍。Kaplan-Meier分析表明，高游离血红蛋白浓度患者的30天生存率明显低于低游离血红蛋白浓度患者。Harboe的分光光度法获得了最佳的结果区分（51.3% vs. 86.4%生存率，p < 0.001;比值比6.1）。包括游离血红蛋白、年龄、SAPS II和SOFA评分以及原降钙素在内的多变量分析表明，通过所有4种方法测定的游离血红蛋白是严重脓毒症死亡的最佳独立预测因素（p = 0.022至p < 0.001）。术后和脓毒症患者的游离血红蛋白浓度在四项测定中的三项中没有显著差异。因此，游离血红蛋白不能用于诊断危重病中的严重脓毒症。游离血红蛋白是严重脓毒症患者生存的一个重要的新预测因子。
Hemolysis can be induced in sepsis via various mechanisms, its pathophysiological importance has been demonstrated in experimental sepsis. However, no data on free hemoglobin concentrations in human sepsis are available. In the present study we measured free hemoglobin in patients with severe sepsis as well as in postoperative patients using four methods. It was our aim to determine the potential value of free hemoglobin as a biomarker for diagnosis and outcome of severe sepsis in critical illness. Plasma concentration of free hemoglobin was determined in patients with severe sepsis (n = 161) and postoperative patients (n = 136) on day 1 of diagnosis and surgery. For the measurement of free hemoglobin, an enzyme linked immunosorbent assay and three spectrophotometric algorithms were used. Moreover, SAPS II- and SOFA scores as well as procalcitonin concentration and outcome were determined. Kaplan-Meier analysis was performed and odds ratios were determined after classification of free hemoglobin concentrations in a high and low concentration group according to the median. For statistical evaluation the Mann-Whitney test and logistic regression analysis were used. In non-survivors of severe sepsis, free hemoglobin concentration was twice the concentration compared to survivors. Thirty-day survival of patients, as evidenced by Kaplan-Meier analysis, was markedly lower in patients with high free hemoglobin concentration than in patients with low free hemoglobin concentration. Best discrimination of outcome was achieved with the spectrophotometric method of Harboe (51.3% vs. 86.4% survival, p < 0.001; odds ratio 6.1). Multivariate analysis including free hemoglobin, age, SAPS II- and SOFA-score and procalcitonin demonstrated that free hemoglobin, as determined by all 4 methods, was the best and an independent predictor for death in severe sepsis (p = 0.022 to p < 0.001). Free hemoglobin concentrations were not significantly different in postoperative and septic patients in three of four assays. Thus, free hemoglobin can not be used to diagnose severe sepsis in critical illness. Free hemoglobin is an important new predictor of survival in severe sepsis.
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DOI：
10.2119/molmed.2010.00149
发表时间：
2011-03
期刊：
Molecular medicine (Cambridge, Mass.)
影响因子：
--
作者：
Ehrnthaller C;Ignatius A;Gebhard F;Huber-Lang M
通讯作者：
Huber-Lang M
影响因子：
20.3
作者：
Nieuwland, R;Berckmans, RJ;Sturk, A
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影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
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Ramsay, G
影响因子：
3.1
作者：
Bloom, O;Wang, HC;Tracey, KJ
通讯作者：
Tracey, KJ
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F