From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.
Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
ASAIO J. 2023 Dec 1;69(12):1099-1105. doi: 10.1097/MAT.0000000000002044. Epub 2023 Oct 3.
Hemolysis is a complication of cardiopulmonary bypass (CPB). Carboxyhemoglobin (COHb) and methemoglobin (MetHb) were suggested as potential hemolysis biomarkers. This retrospective study was based on a prospective registry aimed to determine the association of COHb and MetHb levels with hemolysis in pediatric patients <4 years old who underwent cardiac surgery with CPB. Plasma-free hemoglobin (PFH), COHb, and MetHb levels were measured before CPB; every 30 minutes during CPB; and on postoperative days 1, 2, and 3. Patients were classified into hemolysis and nonhemolysis groups based on the maximum PFH levels during CPB. A total of 193 patients were included. No significant difference was observed in the maximum COHb levels during CPB (COHb CPB ) between the hemolysis and nonhemolysis groups (1.2% [interquartile range {IQR} 0.9-1.4%] vs. 1.1% [IQR: 0.9-1.4%]; p = 0.17). The maximum MetHb levels during CPB (MetHb CPB ) were significantly higher in the hemolysis group than in the nonhemolysis group (1.3% [IQR: 1.1-1.5%] vs. 1.2% [IQR: 1.0-1.4%]; p = 0.007). Areas under the receiver operating curves of COHb CPB and MetHb CPB were 0.557 (95% confidence interval: 0.475-0.640) and 0.615 (95% confidence interval: 0.535-0.695), respectively. Therefore, the predictive ability of both hemolysis biomarkers during CPB is limited.
溶血是体外循环（CPB）的一种并发症。有人提出碳氧血红蛋白（COHb）和高铁血红蛋白（MetHb）可能是潜在的溶血生物标志物。本回顾性研究基于一项旨在确定 CPB 期间 COHb 和 MetHb 水平与小儿 (<4 岁) 心脏手术患者发生溶血之间关联的前瞻性登记研究。CPB 前、CPB 期间每 30 分钟、术后第 1、2、3 天测量血浆游离血红蛋白（PFH）、COHb 和 MetHb 水平。根据 CPB 期间 PFH 最大值将患者分为溶血组和非溶血组。共纳入 193 例患者。CPB 期间最大 COHb 水平（COHb CPB ）在溶血组和非溶血组之间无显著差异（1.2% [四分位距 {IQR}：0.9-1.4%] vs. 1.1% [IQR：0.9-1.4%]；p = 0.17）。CPB 期间最大 MetHb 水平（MetHb CPB ）在溶血组显著高于非溶血组（1.3% [IQR：1.1-1.5%] vs. 1.2% [IQR：1.0-1.4%]；p = 0.007）。COHb CPB 和 MetHb CPB 的受试者工作特征曲线下面积分别为 0.557（95%置信区间：0.475-0.640）和 0.615（95%置信区间：0.535-0.695）。因此，CPB 期间这两种溶血生物标志物的预测能力均有限。
