Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia; Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
J Cardiothorac Vasc Anesth. 2024 Oct;38(10):2221-2230. doi: 10.1053/j.jvca.2024.07.016. Epub 2024 Jul 10.
Carboxyhemoglobin (CO-Hb) is a marker of hemolysis and inflammation, both risk factors for cardiac surgery-associated AKI (CSA-AKI). However, the association between CO-Hb and CSA-AKI remains unknown.
A retrospective cohort study.
Tertiary university-affiliated metropolitan hospital: single center.
Adult on-pump cardiac surgery patients from July 2014 to June 2022 (N = 1,698).
None.
Patients were stratified into quartiles based on CO-Hb levels at intensive care unit (ICU) admission. A progressive increased risk of CSA-AKI was observed with higher CO-Hb levels at ICU admission. On multivariable logistic regression analysis, the highest quartile (CO-Hb ≥ 1.4%) showed an independent association with the occurrence of CSA-AKI (odds ratio 1.45 compared to the lowest quartile [CO-Hb < 1.0%], 95% CI 1.023-2.071; p = 0.038). Compared to patients with CO-Hb <1.4%, patients with CO-Hb ≥ 1.4% at ICU admission had significantly higher postoperative creatinine (135 vs 116 μmol/L, p < 0.001), higher rates of postoperative RRT (6.7% vs 2.3%, p < 0.001) and AKI (p < 0.001) on univariable analysis and shorter time to event for AKI or death (p < 0.001).
CO-Hb ≥ 1.4% at ICU admission is an independent risk factor for CSA-AKI, which is easily obtainable and available on routine arterial blood gas measurements. Thus, CO-Hb may serve as a practical and biologically logical biomarker for risk stratification and population enrichment in trials of CSA-AKI prevention.
碳氧血红蛋白（CO-Hb）是溶血和炎症的标志物，这两者都是心脏手术相关急性肾损伤（CSA-AKI）的危险因素。然而，CO-Hb 与 CSA-AKI 之间的关联尚不清楚。
回顾性队列研究。
三级大学附属都市医院：单中心。
2014 年 7 月至 2022 年 6 月期间接受体外循环心脏手术的成年患者（N=1698）。
无。
根据入住重症监护病房（ICU）时的 CO-Hb 水平，患者被分为四组。在 ICU 入住时 CO-Hb 水平升高，观察到 CSA-AKI 的风险逐渐增加。在多变量逻辑回归分析中，最高四分位数（CO-Hb≥1.4%）与 CSA-AKI 的发生呈独立相关（与最低四分位数[CO-Hb<1.0%]相比，优势比 1.45，95%CI 1.023-2.071；p=0.038）。与 CO-Hb<1.4%的患者相比，入住 ICU 时 CO-Hb≥1.4%的患者术后肌酐水平明显更高（135μmol/L 比 116μmol/L，p<0.001），术后接受肾脏替代治疗（RRT）的比例更高（6.7%比 2.3%，p<0.001），AKI 发生率更高（p<0.001），AKI 或死亡的时间更短（p<0.001）。
入住 ICU 时的 CO-Hb≥1.4%是 CSA-AKI 的独立危险因素，CO-Hb 易于获得，且可通过常规动脉血气测量获得。因此，CO-Hb 可能是 CSA-AKI 预防试验中风险分层和人群富集的实用且合理的生物标志物。
