ArticleTransfusion2018
Elevated free hemoglobin and decreased haptoglobin levels are associated with adverse clinical outcomes, unfavorable physiologic measures, and altered inflammatory markers in pediatric cardiac surgery patients.
Article in Transfusion, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 33 citations in OpenAlex.
- The Effects of Free Heme on Functional and Molecular Changes DuringFrontiers in immunology · 2022Trial
- Stress hyperglycemia ratio in risk stratification and treatment optimization for patients on invasive mechanical ventilation: a secondary analysis of the MIMIC-IV database.BMC infectious diseases · 2026Article
- Signs of Hemolysis Predict Mortality and Ventilator Associated Pneumonia in Severe Acute Respiratory Distress Syndrome Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation.ASAIO journal (American Society for Artificial Internal Organs : 1992) · 2025Article
- Predictive Potential of ECMO Blood Flow for Hemolysis and Outcome of Patients with Severe ARDS.Journal of clinical medicine · 2024Article
- Perioperative Factors and Radiographic Severity Scores for Predicting the Duration of Mechanical Ventilation After Arterial Switch Surgery.Journal of cardiothoracic and vascular anesthesia · 2024Article
- Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management.Anesthesiology · 2023Review
- Potential of cell-free hemoglobin and haptoglobin as prognostic markers in patients with ARDS and treatment with veno-venous ECMO.Journal of intensive care · 2023Article
- Cell-Free Hemoglobin Concentration in Blood Prime Solution Is a Major Determinant of Cell-Free Hemoglobin Exposure during Cardiopulmonary Bypass Circulation in the Newborn.Journal of clinical medicine · 2022Article
- Linking Labile Heme with Thrombosis.Journal of clinical medicine · 2021Review
- Assessment of acute pancreatitis severity via determination of serum levels of hsa-miR-126-5p and IL-6.Experimental and therapeutic medicine · 2021Article
- Chronic Periodontitis and Alzheimer Disease: A Putative Link of Serum Proteins Identification by 2D-DIGE Proteomics.Frontiers in aging neuroscience · 2020Article
- Total plasma heme concentration increases after red blood cell transfusion and predicts mortality in critically ill medical patients.Transfusion · 2019Article
- Retrograde autologous priming method reduces plasma free hemoglobin level in aortic surgery.Annals of cardiac anaesthesiaArticle
Corrections and comments
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Authors and funding
13 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThere are data suggesting that free hemoglobin (Hb), heme, and iron contribute to infection, thrombosis, multiorgan failure, and death in critically ill patients. These outcomes may be mitigated by haptoglobin. STUDY DESIGN AND
methods164 consecutively treated children undergoing surgery for congenital heart disease were evaluated for associations between free Hb and haptoglobin and clinical outcomes, physiologic metrics, and biomarkers of inflammation
resultsHigher perioperative free Hb levels (and lower haptoglobin levels) were associated with mortality, nosocomial infection, thrombosis, hours of intubation and inotropes, increased interleukin-6, peak serum lactate levels, and lower nadir mean arterial pressures. The median free Hb in patients without infection (30 mg/dL; 29 interquartile range [IQR], 24-52 mg/dL) was lower than in those who became infected (39 mg/dL; IQR, 33-88 mg/ 31 dL; p = 0.0046). The median mechanical ventilation requirements were 19 (IQR, 7-72) hours in patients with higher levels of haptoglobin versus 48 (IQR, 18-144) hours in patients with lower levels (p = 0.0047). Transfusion dose, bypass duration, and complexity of surgery were all significantly correlated with Hb levels and haptoglobin levels. Multivariate analyses demonstrated that these variables were independently and significantly associated with outcomes.
conclusionsElevated pre- and postoperative levels of free Hb and decreased levels of haptoglobin were associated with adverse clinical outcomes, inflammation, and unfavorable physiologic metrics. Transfusion, RACHS score, and duration of bypass were associated with increased free Hb and decreased haptoglobin. Further investigation of the role of hemolysis and haptoglobin as potential mediators or markers of outcomes is warranted.
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Registered trials
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