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

Janz DR, Bastarache JA, Peterson JF, Sills G, Wickersham N, May AK, Roberts LJ, Ware LB
Crit Care Med. 2013 41 (3): 784-90

PMID: 23314583 · PMCID: PMC3578977 · DOI:10.1097/CCM.0b013e3182741a54

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.


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.

MeSH Terms (20)

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

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