Hemolysis: A harbinger of adverse outcome after Left ventricular assist device implant
Hemolysis: A harbinger of adverse outcome after Left ventricular assist device implant
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DOI：
10.1016/j.healun.2013.08.021
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发表时间：
2014-01-01
影响因子：
8.9
通讯作者：
Pagani, Francis D.
中科院分区：
文献类型：
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作者：
Cowger, Jennifer A.;Romano, Matthew A.;Pagani, Francis D.
背景技术背景：在左心室辅助装置（LVAD）support.METHODS：乳酸脱氢酶（LDH）和血清游离血红蛋白（sfHg）值升高的溶血血清标志物的临床相关性尚未完全确定每月在HeartMate II（Thoratec，普莱森顿，CA）LVAD支持182例。确定每种标志物的峰值，并将2种溶血定义应用于队列：根据机械辅助循环支持机构间登记处（INTERMACS）标准（sfHg > 40 mg/dl，伴有体征/症状）的溶血和/或由LDH >= 600 IU/L（实验室正常上限的2.5倍）定义的溶血。估计了无死亡、因血栓形成进行器官共享联合网络1A紧急移植、因血栓形成更换器械和卒中/外周栓塞的Kaplan-Meier生存率，并计算了考克斯风险比（BR）和95%置信区间（95% CI）。根据受试者工作特征曲线（AUC）预测1年无事件survival.Results：发生溶血32例（18%）INTERMACS标准和68例（37%）LDH标准的患者。在427天（245，793天）的中位数（第25，75）支持期间，发生了78起事件。发生INTERMACS定义的溶血后1年无事件生存率为16% ± 8.3%，而非溶血者为85% ± 3.2%（HR，14.7; 95% CI，7.9-27; AUC 0.70 ± 0.05; p < 0.001;）。LDH定义的溶血发生后1年无事件生存率为32% +/- 7.2%，而持续LDH值< 600 IU/L的患者为89% +/- 3.2%（HR，8.0; 95% CI，4.4-14; AUC 0.87 +/- 0.04; p < 0.001）。符合LDH溶血定义的患者从溶血发作到临床事件的时间较长，栓塞和血栓形成器械更换的风险程度也较低，而非那些患有LVAD MACS溶血的患者。LDH监测提供了比sfHg更早的不良事件诊断，支持对VAD相关溶血的新INTERMACS定义的需要。(C)2014年国际心肺移植学会。All rights reserved.
BACKGROUND: The clinical relevance of elevated serum markers of hemolysis during left ventricular assist device (LVAD) support has not been fully ascertained.METHODS: Lactate dehydrogenase (LDH) and serum free hemoglobin (sfHg) values were tallied monthly in 182 patients on HeartMate II (Thoratec, Pleasanton, CA) LVAD support. Peak values for each marker were identified, and 2 hemolysis definitions were applied to the cohort: Hemolysis according to Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) criteria (sfHg > 40 mg/dl with signs/symptoms) and/or hemolysis defined by an LDH >= 600 IU/liter (2.5-times the upper limit of laboratory normal). Kaplan-Meier survival free from death, urgent United Network of Organ Sharing 1A transplant for thrombosis, device exchange for thrombosis, and stroke/peripheral embolism was estimated, and Cox hazard ratios (BR) with the 95% confidence interval (95% CI) were calculated. Areas under the receiver-operating characteristic curves (AUCs) for predicting 1-year event-free survival were calculated.RESULTS: Hemolysis occurred in 32 patients (18%) by INTERMACS criteria and in 68 (37%) patients by LDH criteria. Over a median (25th, 75th) support of 427 days (245, 793 days), there were 78 events. One year event-free survival after the onset of INTERMACS-defined hemolysis was 16% +/- 8.3% compared with 85% +/- 3.2% in non-hemolyzers (HR, 14.7; 95% CI, 7.9-27; AUC 0.70 +/- 0.05; p < 0.001;). One year event-free survival after the onset of LDH-defined hemolysis was 32% +/- 7.2% compared with 89% +/- 3.2% in those with persistent LDH values < 600 IU/liter (HR, 8.0; 95% CI, 4.4-14; AUC 0.87 +/- 0.04; p < 0.001). Patients who met the LDH hemolysis definition had longer times from hemolysis onset to clinical events and larger magnitudes of risk for embolism and device exchange for thrombosis than those with ENTERMACS hemolysis.CONCLUSIONS: Serum hemolysis marker elevations are associated with increased events in LVAD patients. LDH monitoring provides an earlier diagnosis of adverse events than sfHg, supporting need for a new INTERMACS definition of VAD-associated hemolysis. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.