Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study.

Pubmed ID: 23314583

Pubmed Central ID: PMC3578977

Journal: Critical care medicine

Publication Date: March 1, 2013

Affiliation: Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. david.janz@vanderbilt.edu

MeSH Terms: Humans, Male, Female, Aged, Odds Ratio, Logistic Models, Middle Aged, Confidence Intervals, Retrospective Studies, Hospital Mortality, Hemoglobins, Intensive Care Units, Sepsis, Acetaminophen, Analgesics, Non-Narcotic, Cell-Free System, F2-Isoprostanes, Oxidative Stress, Qualitative Research, Tertiary Care Centers

Grants: UL1 RR024975, GM42056, HL090785, HL103836, K08 HL090785, K24 HL103836, P01 GM015431, R21 HL112656, T32 HL087738, U01 HL081332, UL1 RR024975-01, R01 GM042056, R37 GM042056

Authors: Ware LB, Janz DR, Bastarache JA, Peterson JF, Sills G, Wickersham N, May AK, Roberts LJ

Cite As: Janz DR, Bastarache JA, Peterson JF, Sills G, Wickersham N, May AK, Roberts LJ 2nd, Ware LB. Association between cell-free hemoglobin, acetaminophen, and mortality in patients with sepsis: an observational study. Crit Care Med 2013 Mar;41(3):784-90.

Studies:

Abstract

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.