학술논문
Methemoglobin as a marker of acute anemic stress in cardiac surgery
Document Type
article
Author
Nikhil Mistry; Gregory M.T. Hare; Nadine Shehata; Robert S. Kramer; Hosam F. Fawzy; Robert A. Baker; Paula Carmona; Richard Saczkowski; Daniela Filipescu; Christella S. Alphonsus; Antoine Rochon; Alexander J. Gregory; Boris Khanykin; Jonathan D. Leff; Eva Mateo; Dimos Karangelis; Juan C. Tellez; Tarit Saha; Dennis T. Ko; Duminda N. Wijeysundera; Subodh Verma; C. David Mazer
Source
iScience, Vol 26, Iss 8, Pp 107429- (2023)
Subject
Language
English
ISSN
2589-0042
Abstract
Summary: Biological evidence supports plasma methemoglobin as a biomarker for anemia-induced tissue hypoxia. In this translational planned substudy of the multinational randomized controlled transfusion thresholds in cardiac surgery (TRICS-III) trial, which included adults undergoing cardiac surgery requiring cardiopulmonary bypass with a moderate-to-high risk of death, we investigated the relationship between perioperative hemoglobin concentration (Hb) and methemoglobin; and evaluated its association with postoperative outcomes. The primary endpoint was a composite of death, myocardial infarction, stroke, and severe acute kidney injury at 28 days. We observe weak non-linear associations between decreasing Hb and increasing methemoglobin, which were strongest in magnitude at the post-surgical time point. Increased levels of post-surgical methemoglobin were associated with a trend toward an elevated risk for stroke and exploratory neurological outcomes. Our generalizable study demonstrates post-surgical methemoglobin may be a marker of anemia-induced organ injury/dysfunction, and may have utility for guiding personalized approaches to anemia management. Clinicaltrials.gov registration NCT02042898.