Document Detail


Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study.
MedLine Citation:
PMID:  23314583     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the association of circulating cell-free hemoglobin with poor clinical outcomes in patients with sepsis and to characterize the potential protective effects of acetaminophen, an inhibitor of hemoprotein-mediated oxidation.
DESIGN: Retrospective observational study.
PATIENTS: A total of 391 critically ill patients with sepsis in multiple ICUs in an academic tertiary care hospital.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Nonsurvivors had significantly higher plasma cell-free hemoglobin concentrations (median 20mg/dL, interquartile range 10-40) measured on enrollment compared to survivors (10mg/dL, interquartile range 10-30, p = 0.002). After controlling for potential confounders, patients with higher cell-free hemoglobin concentrations were significantly more likely to die in the hospital (odds ratio 1.078, 95% confidence interval 1.012-1.149, p = 0.02). In addition, receiving acetaminophen in the setting of increased cell-free hemoglobin was independently associated with a protective effect against death (odds ratio 0.48, 95% confidence interval 0.25-0.91, p = 0.026) and lower plasma concentrations of the lipid peroxidation product F2-isoprostanes (18.5 pg/mL, interquartile range 9-22.2) compared to no acetaminophen (42 pg/mL, interquartile range 29.7-86, p = 0.009).
CONCLUSIONS: In critically ill patients with sepsis, elevated concentrations of circulating cell-free hemoglobin are independently associated with an increased risk of death. Acetaminophen may exert a protective effect by reducing cell-free hemoglobin-induced oxidative injury.
Authors:
David R Janz; Julie A Bastarache; Josh F Peterson; Gillian Sills; Nancy Wickersham; Addison K May; L Jackson Roberts; Lorraine B Ware
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-21     Completed Date:  2013-04-16     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  784-90     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / pharmacology*
Aged
Analgesics, Non-Narcotic / pharmacology*
Cell-Free System
Confidence Intervals
F2-Isoprostanes / blood
Female
Hemoglobins / metabolism*
Hospital Mortality*
Humans
Intensive Care Units
Logistic Models
Male
Middle Aged
Odds Ratio
Oxidative Stress / drug effects*
Qualitative Research
Retrospective Studies
Sepsis / blood,  mortality*
Tertiary Care Centers
Grant Support
ID/Acronym/Agency:
GM42056/GM/NIGMS NIH HHS; HL090785/HL/NHLBI NIH HHS; HL103836/HL/NHLBI NIH HHS; K08 HL090785/HL/NHLBI NIH HHS; K24 HL103836/HL/NHLBI NIH HHS; R21 HL112656/HL/NHLBI NIH HHS; U01 HL081332/HL/NHLBI NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975-01/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/F2-Isoprostanes; 0/Hemoglobins; 362O9ITL9D/Acetaminophen
Comments/Corrections
Comment In:
Crit Care Med. 2013 Aug;41(8):e186   [PMID:  23863257 ]
Crit Care Med. 2013 Aug;41(8):e186-9   [PMID:  23863256 ]
Crit Care Med. 2013 Mar;41(3):919-20   [PMID:  23425828 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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