Undetectable haptoglobin is associated with major adverse kidney events in critically ill burn patients

Abstract

BackgroundIntravascular haemolysis has been associated with acute kidney injury (AKI) in different clinical settings (cardiac surgery, sickle cell disease). Haemolysis occurs frequently in critically ill burn patients. The aim of this study was to assess the predictive value of haptoglobin at admission to predict major adverse kidney events (MAKE) and AKI in critically ill burn patients.MethodsWe conducted a retrospective, single-centre cohort study in a burn critical care unit in a tertiary centre, including all consecutive severely burned patients (total burned body surface > 20% and/or shock and/or mechanical ventilation at admission) from January 2012 to April 2017 with a plasmatic haptoglobin dosage at admission.ResultsA total of 130 patients were included in the analysis. Their mean age was 49 (34–62) years, their median total body surface area burned was 29% (15–51%) and the intensive care unit (ICU) mortality was 25%. Early haemolysis was defined as an undetectable plasmatic haptoglobin at admission. We used logistic regression to identify MAKE and AKI risk factors. In multivariate analysis, undetectable haptoglobin was associated with MAKE and AKI (respectively, OR 6.33, 95% CI 2.34–16.45, p < 0.001; OR 8.32, 95% CI 2.86–26.40, p < 0.001).ConclusionsUndetectable plasmatic haptoglobin at ICU admission is an independent risk factor for MAKE and AKI in critically ill burn patients. This study provides a rationale for biomarker-guided therapy using haptoglobin in critically ill burn patients.

Multiple biomarkers of sepsis identified by novel time-lapse proteomics of patient serum

“…Previous studies have also suggested the administration of haptoglobin as a therapeutic strategy against lethal sepsis and liver injury [38]. Major adverse kidney events, a complication common to severe sepsis, have been associated with haptoglobin levels below the detection limit of typical measurements in burn patients [39]. Hence, this would seem to suggest that the dip in HP protein observed, could be a useful new biomarker for sepsis progression.…”

Long-term outcomes after extracorporeal membrane oxygenation in patients with dialysis-requiring acute kidney injury: A cohort study

“…[ 14 , 15 ] A composite of renal outcomes, named major adverse kidney events (MAKE), has been endorsed by the National Institute of Diabetes and Digestive and Kidney Diseases clinical trials workgroup and used in recent studies. [ 16 – 19 ]…”

Haptoglobin use and acute kidney injury requiring renal replacement therapy among patients with severe burn injury: a nationwide database study

“…Recently, Kubota et al [15] reported in their singlecenter retrospective study that haptoglobin provision during cardiovascular surgery was associated with a lower risk of post-operative AKI. More recently, Depret et al [22] reported that undetectable plasma haptoglobin was associated with major adverse kidney events in critically ill patients with burns. They provided a possible rationale for a biomarker-guided therapy using haptoglobin in patients with severe burns [22].…”

“…More recently, Depret et al [22] reported that undetectable plasma haptoglobin was associated with major adverse kidney events in critically ill patients with burns. They provided a possible rationale for a biomarker-guided therapy using haptoglobin in patients with severe burns [22].…”

“…However, haptoglobin provision in patients with burns has been described only in a few case reports [14,20,21] and one small case-series (n = 10) from Japan [11]. Recently, Depret et al [22] reported in their singlecenter retrospective cohort study (n = 130) that undetectable (low plasma) haptoglobin was associated with major adverse kidney events in critically ill patients with burns. These data suggested that provision of haptoglobin may be rational for preventing AKI in severe burns; however, no robust clinical evidence supports this idea.…”