Jansma Geertje, de Lange Fellery, Kingma W Peter, Vellinga Namkje A R, Koopmans Matty, Kuiper Michael A, Boerma E Christiaan
Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
BMC Anesthesiol. 2015 Apr 24;15:55. doi: 10.1186/s12871-015-0035-7.
Anemia is a common feature during sepsis that occurs due to iatrogenic blood loss, depression of serum iron levels and erythropoietin production, and a decreased lifespan of erythrocytes. However, these mechanisms are unlikely to play a role in anemia at the start of sepsis. Moreover, sequestration of fluids, renal failure and increase of intravascular space may additionally influence the change in hemoglobin concentration during intravenous fluid administration in the acute phase of sepsis.
In this retrospective study, patients who were admitted acutely to the Intensive Care Unit (ICU) were included. Patients who fulfilled the international criteria for severe sepsis or septic shock were included in the sepsis group (S-group). The remaining patients were allocated to the control group (C-group). Laboratory data from blood samples taken at first presentation to the hospital and at admission to the ICU, the amount of intravenous fluid administration and length of stay in the emergency department were collected and tested for significant differences between groups.
The difference in hemoglobin concentration between the S-group (n = 296) and C-group (n = 320) at first presentation in hospital was not significant (8.8 ± 1.2 versus 8.9 ± 1.2 mmol/l, respectively, p = 0.07). The reduction in hemoglobin concentration from the first presentation at the emergency department to ICU admission was significantly greater in the S-group compared to the C-group (1 [0.5-1.7] versus 0.5 [0.1-1.1] mmol/l, (p < 0.001)). Spearman rho correlation coefficients between the reduction in hemoglobin concentration and the amount of intravenous fluids administered or the creatinine level in the emergency department were significant (0.3 and 0.4, respectively, p < 0.001). In a multivariate regression analysis, creatinine, the amount of fluid administration and the presence of sepsis remained independently associated.
Prior to in-hospital intravenous fluid administration, there is no significant difference in hemoglobin concentration between acute septic patients and acutely ill controls. Within several hours after hospital admission, there is a significant reduction in hemoglobin concentration, not only associated with the amount of intravenous fluids administered and the creatinine level, but also independently with sepsis itself.
贫血是脓毒症期间的常见特征，其发生原因包括医源性失血、血清铁水平和促红细胞生成素生成受抑制以及红细胞寿命缩短。然而，这些机制在脓毒症初期不太可能导致贫血。此外，液体潴留、肾衰竭和血管内空间增加可能会在脓毒症急性期静脉输液期间额外影响血红蛋白浓度的变化。
在这项回顾性研究中，纳入了急性入住重症监护病房（ICU）的患者。符合严重脓毒症或脓毒性休克国际标准的患者被纳入脓毒症组（S组）。其余患者被分配到对照组（C组）。收集首次入院时和入住ICU时采集的血样的实验室数据、静脉输液量以及在急诊科的住院时间，并对两组之间的显著差异进行检测。
S组（n = 296）和C组（n = 320）在首次入院时血红蛋白浓度的差异不显著（分别为8.8±1.2与8.9±1.2 mmol/L，p = 0.07）。与C组相比，S组从急诊科首次就诊到入住ICU期间血红蛋白浓度的降低显著更大（1 [0.5 - 1.7]与0.5 [0.1 - 1.1] mmol/L，（p < 0.001））。血红蛋白浓度降低与急诊科静脉输液量或肌酐水平之间的斯皮尔曼等级相关系数显著（分别为0.3和0.4，p < 0.001）。在多变量回归分析中，肌酐、输液量和脓毒症的存在仍独立相关。
在住院静脉输液前，急性脓毒症患者与急性病对照组之间的血红蛋白浓度无显著差异。入院后数小时内，血红蛋白浓度显著降低，这不仅与静脉输液量和肌酐水平有关，还与脓毒症本身独立相关。
