Cargando…
Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome
Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concen...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219926/ https://www.ncbi.nlm.nih.gov/pubmed/34179033 http://dx.doi.org/10.3389/fmed.2021.639803 |
_version_ | 1783711044321935360 |
---|---|
author | Schriefl, Christoph Schoergenhofer, Christian Ettl, Florian Poppe, Michael Clodi, Christian Mueller, Matthias Grafeneder, Juergen Jilma, Bernd Magnet, Ingrid Anna Maria Buchtele, Nina Boegl, Magdalena Sophie Holzer, Michael Sterz, Fritz Schwameis, Michael |
author_facet | Schriefl, Christoph Schoergenhofer, Christian Ettl, Florian Poppe, Michael Clodi, Christian Mueller, Matthias Grafeneder, Juergen Jilma, Bernd Magnet, Ingrid Anna Maria Buchtele, Nina Boegl, Magdalena Sophie Holzer, Michael Sterz, Fritz Schwameis, Michael |
author_sort | Schriefl, Christoph |
collection | PubMed |
description | Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA. Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression. Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014). Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period. |
format | Online Article Text |
id | pubmed-8219926 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82199262021-06-24 Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome Schriefl, Christoph Schoergenhofer, Christian Ettl, Florian Poppe, Michael Clodi, Christian Mueller, Matthias Grafeneder, Juergen Jilma, Bernd Magnet, Ingrid Anna Maria Buchtele, Nina Boegl, Magdalena Sophie Holzer, Michael Sterz, Fritz Schwameis, Michael Front Med (Lausanne) Medicine Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA. Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression. Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014). Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period. Frontiers Media S.A. 2021-06-09 /pmc/articles/PMC8219926/ /pubmed/34179033 http://dx.doi.org/10.3389/fmed.2021.639803 Text en Copyright © 2021 Schriefl, Schoergenhofer, Ettl, Poppe, Clodi, Mueller, Grafeneder, Jilma, Magnet, Buchtele, Boegl, Holzer, Sterz and Schwameis. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Schriefl, Christoph Schoergenhofer, Christian Ettl, Florian Poppe, Michael Clodi, Christian Mueller, Matthias Grafeneder, Juergen Jilma, Bernd Magnet, Ingrid Anna Maria Buchtele, Nina Boegl, Magdalena Sophie Holzer, Michael Sterz, Fritz Schwameis, Michael Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome |
title | Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome |
title_full | Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome |
title_fullStr | Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome |
title_full_unstemmed | Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome |
title_short | Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome |
title_sort | change of hemoglobin levels in the early post-cardiac arrest phase is associated with outcome |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219926/ https://www.ncbi.nlm.nih.gov/pubmed/34179033 http://dx.doi.org/10.3389/fmed.2021.639803 |
work_keys_str_mv | AT schrieflchristoph changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT schoergenhoferchristian changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT ettlflorian changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT poppemichael changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT clodichristian changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT muellermatthias changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT grafenederjuergen changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT jilmabernd changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT magnetingridannamaria changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT buchtelenina changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT boeglmagdalenasophie changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT holzermichael changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT sterzfritz changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome AT schwameismichael changeofhemoglobinlevelsintheearlypostcardiacarrestphaseisassociatedwithoutcome |