Haemolysis index: validation for haemolysis detection during extracorporeal membrane oxygenation

Boissier, Elodie; Lakhal, Karim; Sénage, Thomas; Bizouarn, Philippe; Lepoivre, Thierry; Nicolet, Johanna; Roussel, Jean‐Christian; Rozec, Bertrand; Vourc’h, Mickaël; Bigot‐Corbel, Edith

doi:10.1016/j.bja.2020.04.080

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…5,6 The mechanisms include turbulent blood flow, damage by small fibrin strands or clots, release of gaseous microbubbles, or cavitation of red cells exposed to negative pressure through the circuit. 7 In clinical practice, a combination of physical findings such as red, discolored urine, circuit findings including negative inlet pressure, and/or formation of clots, and plasma markers such as bilirubin, lactate dehydrogenase, and free plasma hemoglobin are used to indicate the presence of hemolysis, however these are non-specific.…”

Section: Introductionmentioning

confidence: 99%

Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study

et al. 2021

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Introduction: Hemolysis is a common complication of extracorporeal membrane oxygenation (ECMO). There are few data on whether carboxyhemoglobin (COHb), a potential marker of hemolysis, are elevated during ECMO support. Methods: We conducted a single-center, retrospective study comparing peak COHb levels of children pre-, during, and post-ECMO from January 2017 to August 2020. Results: There were 154 ECMO runs in 147 children (154 PICU admissions) included in the study. The median age was 3.5 (IQR 0.2, 39.2) months. Veno-arterial ECMO was the predominant mode: 146/154 (94.8%). Eighty-seven children (56.5%) underwent cardiac surgery. Peak COHb levels during ECMO were statistically significantly higher compared to pre ECMO (COHb 1.8% (IQR 1.4, 2.6) vs COHb 1.2% (IQR 0.7, 1.7), p < 0.001) and post ECMO (COHb 1.6% (IQR 1.3, 2.2), p = 0.009). Children with COHb ⩾2% were younger and had longer duration of ECMO support. Plasma hemoglobin weakly correlated with COHb level ( r = 0.14; p = 0.04). Conclusions: Carboxyhemoglobin levels increased during ECMO support compared to the pre and post ECMO period. Younger age and longer ECMO duration were associated with COHb levels ⩾2%. Plasma hemoglobin weakly correlated with COHb level.

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Section: Introductionmentioning

confidence: 99%

Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study

et al. 2021

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“…Indeed, it is unclear whether the HI – an in vitro tool proposed to detect haemolysis related to sample collection, transport, and processing – could be used to assess in vivo haemolysis after cardiac surgery, that is, could be used as a surrogate for free haemoglobin. However, the HI has been validated as a reliable gauge for ECMO-induced haemolysis 7,8 and for haemolysis from various causes. 22 Hence, we believe that interchangeability between HI and free haemoglobin measurements is likely for the detection of cardiac surgery-induced haemolysis although dedicated studies are required.…”

Section: Discussionmentioning

confidence: 99%

“…a surrogate for free haemoglobin. However, the HI has been validated as a reliable gauge for ECMO-induced haemolysis 7,8 and for haemolysis from various causes. 22 Hence, we believe that interchangeability between HI and free haemoglobin measurements is likely for the detection of cardiac surgery-induced haemolysis although dedicated studies are required.…”

Section: Discussionmentioning

confidence: 99%

“…Haemolysis index, as a surrogate for free haemoglobin, is a reliable marker of haemolysis during extra-corporeal membrane oxygenation, with low inter-measurement variability. 7,8…”

Section: Introductionmentioning

confidence: 99%

“…Haemolysis index, as a surrogate for free haemoglobin, is a reliable marker of haemolysis during extra-corporeal membrane oxygenation, with low inter-measurement variability. 7,8 The higher the intra-and postoperative systemic inflammatory response, the higher the circulating levels of cytokines such as the interleukine-6 (IL-6) 9 and probably the higher the risk of CS-AKI, according to the few available studies addressing this issue. [10][11][12][13][14] Of note, no study tested the combination of IL-6 with an indicator of haemolysis.…”

Section: Introductionmentioning

confidence: 99%

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Plasma haemolysis index and interleukine-6 for the early prediction of cardiac surgery-associated acute kidney injury. A proof-of-concept study

et al. 2022

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Introduction Haemolysis and inflammation contribute to cardiac surgery-associated acute kidney injury (CS-AKI). We aimed to assess the performance of plasma haemolysis index (HI) and interleukine-6 (IL-6) for the prediction of all-stage CS-AKI. We also assessed their ability to predict moderate-to-severe CS-AKI and to discriminate persistent from transient CS-AKI. Methods Adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were prospectively included. Haemolysis index and IL-6 were measured immediately after the end of CPB and 6 hours later. Correction for haemodilution relied upon changes in albuminaemia. Persistent CS-AKI was defined as a steady/increasing CS-AKI stage between the 48th and the 60th postoperative hour as compared with the worst stage observed within the 48 first hours. Results Among 82 patients, CS-AKI occurred in 37 (45%) patients. Postoperative HI and IL-6 were positively correlated to the duration of CPB (r ≤ 0.51, p ≤ 0.0003). Whether we considered isolated measurements of HI or IL-6, their indexation to haemodilution or not, their kinetics and/or their combination, the prediction of all stage CS-AKI was inaccurate (area under the receiver operating characteristic curve [AUCROC]≤ 0.68) whereas moderate-to-severe CS-AKI (6 patients only) was predicted with an honourable performance (AUCROC = 0.77 [95%CI 0.67;0.86] and 0.87 [95%CI 0.77;0.93] for HI and IL-6, respectively). The persistent/transient nature of CS-AKI was inaccurately predicted (AUCROC ≤ 0.68). Conclusions In a population in which most CS-AKI cases were mild, although they frequently (41%) persisted >48 hours, CS-AKI was inaccurately predicted by HI and/or IL-6. A better performance for moderate-to-severe CS-AKI prediction is likely. These preliminary findings are yet to be validated.

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Automated Monitoring of Plasma-free Hemoglobin on Routine Clinical Chemistry Platforms

Bosma¹,

Scholten²,

Rigter³

et al. 2021

ASAIO Journal

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Haemolysis index: validation for haemolysis detection during extracorporeal membrane oxygenation

Cited by 6 publications

References 11 publications

Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study

Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study

Plasma haemolysis index and interleukine-6 for the early prediction of cardiac surgery-associated acute kidney injury. A proof-of-concept study

Automated Monitoring of Plasma-free Hemoglobin on Routine Clinical Chemistry Platforms

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