游离血红蛋白升高：创伤性损伤后的一种新型早期生物标志物。
Elevated cell-free hemoglobin: A novel early biomarker following traumatic injury.
作者信息
Ross James T, Robles Anamaria J, Barnes Ashli, Bellini Alyssa R, Mansour Alexandre, Nesseler Nicolas, Reynolds James D, Remy Kenneth E, Callcut Rachael A
机构信息
From the Department of Surgery (J.T.R.), and Blood, Heart, Lung, and Immunology Research Center (J.T.R., K.E.R.), University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Surgery (A.J.R., A.B., A.R.B., R.A.C.), University of California Davis, Sacramento, California; Department of Anesthesia and Critical Care (A.M., N.N.), Pontchaillou University Hospital of Rennes, Rennes, France; Department of Anesthesiology and Perioperative Medicine (J.D.R.), University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; and Division of Pulmonary Critical Care Medicine, Department of Medicine (K.E.R.), University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio.
出版信息
J Trauma Acute Care Surg. 2025 Mar 1;98(3):378-384. doi: 10.1097/TA.0000000000004543. Epub 2024 Dec 26.
BACKGROUND
Cell-free hemoglobin (CFH) and free heme are potent mediators of endotheliopathy and organ injury in sepsis, but their roles in other hemolytic pathologies are not well-defined. A prime example is trauma where early hemolysis may initiate damage and predict outcome. Here, we investigated the presence of plasma CFH, heme, and their major scavengers after traumatic injury.
METHODS
Adult patients who presented as highest-level activations were prospectively enrolled at a level 1 trauma center between 2021 and 2023. Venous blood was collected upon arrival (pretransfusion) and 6, 12, and 24 hours after admittance for quantification of CFH, haptoglobin, heme, and hemopexin.
RESULTS
We studied 119 mostly male subjects (101:18) with a median age of 48 years (interquartile range [IQR], 31-64 years) and an Injury Severity Score of 22 (IQR, 11-29); the majority had suffered blunt force trauma. The 28-day mortality rate was 11%. Cell-free hemoglobin was high upon emergency department arrival (10.9 μM; IQR, 6.8-17.6) and then declined but remained elevated compared with normative levels during the monitoring period (>5 vs. ~0.2 μM). The initial drop in CFH was attributed to haptoglobin binding and clearance. Notably, there was a subgroup of patients with two- to threefold higher levels of CFH on emergency department arrival (median, 25 μM). Patients with these highest CFH levels had longer hospital stays and more frequent complications.
CONCLUSION
Cell-free hemoglobin is elevated in trauma patients very early after injury and may impact outcome. While further work is needed, early correction of hemolysis could provide benefit.
LEVEL OF EVIDENCE
Prognostic/Epidemiological Study; Level III.
背景
无细胞血红蛋白（CFH）和游离血红素是脓毒症中内皮病变和器官损伤的强效介质，但它们在其他溶血性疾病中的作用尚不明确。一个典型例子是创伤，早期溶血可能引发损伤并预测预后。在此，我们调查了创伤性损伤后血浆CFH、血红素及其主要清除剂的存在情况。
方法
2021年至2023年期间，在一家一级创伤中心前瞻性纳入表现为最高级别激活的成年患者。入院时（输血前）以及入院后6、12和24小时采集静脉血，用于定量CFH、触珠蛋白、血红素和血红素结合蛋白。
结果
我们研究了119名主要为男性的受试者（101:18），中位年龄为48岁（四分位间距[IQR]，31 - 64岁），损伤严重程度评分为22（IQR，11 - 29）；大多数患者遭受钝器创伤。28天死亡率为11%。急诊科入院时无细胞血红蛋白水平较高（10.9 μM；IQR，6.8 - 17.6），随后下降，但在监测期内仍高于正常水平（>5 vs. ~0.2 μM）。CFH的初始下降归因于触珠蛋白的结合和清除。值得注意的是，有一组患者在急诊科入院时CFH水平高出两到三倍（中位值，25 μM）。这些CFH水平最高的患者住院时间更长，并发症更频繁。
结论
创伤患者在受伤后早期无细胞血红蛋白水平升高，可能影响预后。虽然还需要进一步研究，但早期纠正溶血可能有益。
证据级别
预后/流行病学研究；三级。
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