Baldetti Luca, Labanca Rosa, Belletti Alessandro, Dias-Frias André, Peveri Beatrice, Kotani Yuki, Fresilli Stefano, Calvo Francesco, Fominskiy Evgeny, Pieri Marina, Ajello Silvia, Scandroglio Anna Mara
Cardiac Intensive Care Unit, IRCCS "San Raffaele Scientific Institute,", Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy,
Blood Purif. 2024;53(11-12):851-859. doi: 10.1159/000539363. Epub 2024 Aug 5.
Exogenous haptoglobin administration may enhance plasma-free hemoglobin (pfHb) clearance during hemolysis and reduce its end-organ damage: we systematically reviewed and summarized available evidence on the use of haptoglobin as a treatment for hemolysis of any cause.
We included studies describing haptoglobin administration as treatment or prevention of hemolysis-related complications. Only studies with a control group reporting at least one of the outcomes of interest were included in the quantitative synthesis. Primary outcome was the change in pfHb concentration 1 h after haptoglobin infusion.
Among 573 articles, 13 studies were included in the review (677 patients, 52.8% received haptoglobin). Median initial haptoglobin intravenous bolus was 4,000 (2,000, 4,000) IU. Haptoglobin was associated with lower pfHb 1 h (SMD -11.28; 95% CI: -15.80 to -6.75; p < 0.001) and 24 h (SMD -2.65; 95% CI: -4.73 to -0.57; p = 0.001) after infusion. There was no difference in all-cause mortality between haptoglobin-treated patients and control group (OR 1.41; 95% CI: 0.49-4.95; p = 0.520). Haptoglobin was associated with a lower incidence of acute kidney injury (OR 0.64; 95% CI: 0.44-0.93; p = 0.020). No adverse events or side effects associated with haptoglobin use were reported.
Haptoglobin administration has been used in patients with hemolysis from any cause to treat or prevent hemolysis-associated adverse events. Haptoglobin may reduce levels of pfHb and preserve kidney function without increase in adverse events.
外源性给予结合珠蛋白可能会增强溶血过程中血浆游离血红蛋白(pfHb)的清除,并减少其对终末器官的损害:我们系统回顾并总结了关于使用结合珠蛋白治疗任何原因引起的溶血的现有证据。
我们纳入了将给予结合珠蛋白描述为治疗或预防溶血相关并发症的研究。只有设有对照组且报告了至少一项感兴趣结局的研究才纳入定量分析。主要结局是输注结合珠蛋白1小时后pfHb浓度的变化。
在573篇文章中,13项研究被纳入综述(677例患者,52.8%接受了结合珠蛋白治疗)。结合珠蛋白静脉推注的初始中位数剂量为4000(2000,4000)IU。输注结合珠蛋白后1小时(标准化均值差 -11.28;95%置信区间:-15.80至-6.75;p < 0.001)和24小时(标准化均值差 -2.65;95%置信区间:-4.73至-0.57;p = 0.001)时,结合珠蛋白与较低的pfHb水平相关。结合珠蛋白治疗组患者与对照组之间的全因死亡率无差异(比值比1.41;95%置信区间:0.49 - 4.95;p = 0.520)。结合珠蛋白与急性肾损伤发生率较低相关(比值比0.64;95%置信区间:0.44 - 0.93;p = 0.020)。未报告与使用结合珠蛋白相关的不良事件或副作用。
结合珠蛋白已被用于治疗任何原因引起溶血的患者,以治疗或预防与溶血相关的不良事件。结合珠蛋白可能会降低pfHb水平并保护肾功能,且不会增加不良事件的发生。