دورية أكاديمية
أعرض في EDS

U-Shaped Association Between Carboxyhemoglobin and Mortality in Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation.

التفاصيل البيبلوغرافية
العنوان: U-Shaped Association Between Carboxyhemoglobin and Mortality in Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation.
المؤلفون: Meservey A; Department of Medicine, Duke University School of Medicine, Durham, NC., Krishnan G; Department of Medicine, Duke University School of Medicine, Durham, NC., Green CL; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC., Morrison S; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC., Rackley CR; Department of Medicine, Duke University School of Medicine, Durham, NC., Kraft BD; Department of Medicine, Duke University School of Medicine, Durham, NC.
المصدر: Critical care explorations [Crit Care Explor] 2023 Aug 21; Vol. 5 (8), pp. e0957. Date of Electronic Publication: 2023 Aug 21 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101746347 Publication Model: eCollection Cited Medium: Internet ISSN: 2639-8028 (Electronic) Linking ISSN: 26398028 NLM ISO Abbreviation: Crit Care Explor Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Philadelphia, PA : Wolters Kluwer Health, [2019]-
مستخلص: Background: Carbon monoxide (CO) is an endogenous signaling molecule that activates cytoprotective programs implicated in the resolution of acute respiratory distress syndrome (ARDS) and survival of critical illness. Because CO levels can be measured in blood as carboxyhemoglobin, we hypothesized that carboxyhemoglobin percent (COHb%) may associate with mortality.
Objectives: To examine the relationship between COHb% and outcomes in patients with ARDS requiring venovenous extracorporeal membrane oxygenation (ECMO), a condition where elevated COHb% is commonly observed.
Design: Retrospective cohort study.
Setting: Academic medical center ICU.
Patients: Patients were included that had ARDS on venovenous ECMO.
Measurements and Main Results: We examined the association between COHb% and mortality using a Cox proportional hazards model. Secondary outcomes including ECMO duration, ventilator weaning, and hospital and ICU length of stay were examined using both subdistribution and causal-specific hazard models for competing risks. We identified 109 consecutive patients for analysis. Mortality significantly decreased per 1 U increase in COHb% below 3.25% (hazard ratio [HR], 0.35; 95% CI, 0.15-0.80; p = 0.013) and increased per 1 U increase above 3.25% (HR, 4.7; 95% CI, 1.5-14.7; p = 0.007) reflecting a nonlinear association ( p = 0.006). Each unit increase in COHb% was associated with reduced likelihood of liberation from ECMO and mechanical ventilation, and increased time to hospital and ICU discharge (all p < 0.05). COHb% was significantly associated with hemolysis but not with initiation of hemodialysis or blood transfusions.
Conclusions: In patients with ARDS on venovenous ECMO, COHb% is a novel biomarker for mortality exhibiting a U-shaped pattern. Our findings suggest that too little CO (perhaps due to impaired host signaling) or excess CO (perhaps due to hemolysis) is associated with higher mortality. Patients with low COHb% may exhibit the most benefit from future therapies targeting anti-oxidant and anti-inflammatory pathways such as low-dose inhaled CO gas.
Competing Interests: bFine & Gray’s competing risk model. Dr. Rackley reports honoraria from Inspira and Roche. Dr. Kraft reports grant funding from the Department of Defense, National Institutes of Health, and Bluejay Diagnostics; and honoraria from Eli Lilly, Bluejay Diagnostics, and GST Micro. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
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معلومات مُعتمدة: T32 HL007843 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: carbon monoxide; carboxyhemoglobin; extracorporeal membrane oxygenation; hemolysis; respiratory distress syndrome
تواريخ الأحداث: Date Created: 20230824 Latest Revision: 20240313
رمز التحديث: 20240313
مُعرف محوري في PubMed: PMC10443764
DOI: 10.1097/CCE.0000000000000957
PMID: 37614802
قاعدة البيانات: MEDLINE
الوصف
تدمد:2639-8028
DOI:10.1097/CCE.0000000000000957