Prognostic Value of Carboxyhemoglobin in Pediatric Intensive Care Unit

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2022 Oct 17

PMID 36246687

Authors

Mehmet Alakaya

Ali Ertug Arslankoylu

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine the carboxyhemoglobin (COHb) levels of the patients admitted to the pediatric intensive care unit and investigate its relationship with prognosis.

Methods: This retrospective observational study included patients aged one month to 18 years admitted to Mersin University Hospital pediatric intensive care unit from January 2020 to January 2021. Demographic characteristics, hospitalization causes, PRISM III, PELOD scores, hospitalization length, mechanical ventilation supports, transfusion needs, lactate and, SpCO levels of all patients were determined. SpCO levels of the excitus and surviving patients were compared, and the relationship with mortality was investigated.

Results: Total 365 patients were included in the study. The median carboxyhemoglobin level of the excitus patients was statistically significantly higher when compared to the level of the surviving patients [(1.8(1.4-2,4) vs 0.65(0-1) p<0.001]). For mortality prediction, the cut-off point for SpCO, which was determined with 100% sensitivity and 96.5% specificity, was calculated as 1.3.

Conclusion: Since SpCO levels are increased in critically ill children and correlate with increased PICU mortality, SpCO may be a predictive marker for prognosis in PICU.

References

Sakamoto A, Nakanishi K, Takeda S, Ogawa R . Does carboxy-hemoglobin serve as a stress-induced inflammatory marker reflecting surgical insults?. J Nippon Med Sch. 2005; 72(1):19-28. DOI: 10.1272/jnms.72.19. View

Morimatsu H, Takahashi T, Maeshima K, Inoue K, Kawakami T, Shimizu H . Increased heme catabolism in critically ill patients: correlation among exhaled carbon monoxide, arterial carboxyhemoglobin, and serum bilirubin IXalpha concentrations. Am J Physiol Lung Cell Mol Physiol. 2005; 290(1):L114-9. DOI: 10.1152/ajplung.00031.2005. View

Weng Y, Tatarov A, Bartos B, Contag C, Dennery P . HO-1 expression in type II pneumocytes after transpulmonary gene delivery. Am J Physiol Lung Cell Mol Physiol. 2000; 278(6):L1273-9. DOI: 10.1152/ajplung.2000.278.6.L1273. View

Yasuda H, Yamaya M, Yanai M, Ohrui T, Sasaki H . Increased blood carboxyhaemoglobin concentrations in inflammatory pulmonary diseases. Thorax. 2002; 57(9):779-83. PMC: 1746434. DOI: 10.1136/thorax.57.9.779. View

Araujo J, Zhang M, Yin F . Heme oxygenase-1, oxidation, inflammation, and atherosclerosis. Front Pharmacol. 2012; 3:119. PMC: 3400084. DOI: 10.3389/fphar.2012.00119. View

Carmona-Montesinos E, Velazquez-Perez R, Pichardo Aguirre E, Rivas-Arancibia S . Obesity, Oxidative Stress, and Their Effect on Serum Heme Oxygenase-1 Concentrations and Insulin in Children Aged 3 to 5 Years in a Pediatric Hospital of the Ministry of Health CDMX. Child Obes. 2016; 12(6):474-481. DOI: 10.1089/chi.2016.0155. View

Roth D, Herkner H, Schreiber W, Hubmann N, Gamper G, Laggner A . Accuracy of noninvasive multiwave pulse oximetry compared with carboxyhemoglobin from blood gas analysis in unselected emergency department patients. Ann Emerg Med. 2011; 58(1):74-9. DOI: 10.1016/j.annemergmed.2010.12.024. View

Puyana S, Ruiz S, Amador F, Hai S, Young E, Lim R . Admission Carboxyhemoglobin: Is It a Marker for Burn Patient Outcomes?. Ann Plast Surg. 2020; 85(4):376-378. DOI: 10.1097/SAP.0000000000002455. View

Ryter S, Otterbein L . Carbon monoxide in biology and medicine. Bioessays. 2004; 26(3):270-80. DOI: 10.1002/bies.20005. View

10.

Mumby S, Upton R, Chen Y, Stanford S, Quinlan G, Nicholson A . Lung heme oxygenase-1 is elevated in acute respiratory distress syndrome. Crit Care Med. 2004; 32(5):1130-5. DOI: 10.1097/01.ccm.0000124869.86399.f2. View

11.

Fazekas A, Wewalka M, Zauner C, Funk G . Carboxyhemoglobin levels in medical intensive care patients: a retrospective, observational study. Crit Care. 2012; 16(1):R6. PMC: 3396235. DOI: 10.1186/cc11138. View

12.

Hariri G, Hodjat Panah K, Beneteau-Burnat B, Chaquin M, Mekinian A, Ait-Oufella H . Carboxyhemoglobin, a reliable diagnosis biomarker for hemolysis in intensive care unit: a retrospective study. Crit Care. 2021; 25(1):7. PMC: 7786981. DOI: 10.1186/s13054-020-03437-w. View

13.

Lozar-Krivec J, Bratanic B, Paro-Panjan D . The role of carboxyhemoglobin measured with CO-oximetry in the detection of hemolysis in newborns with ABO alloimmunization. J Matern Fetal Neonatal Med. 2015; 29(3):452-6. DOI: 10.3109/14767058.2015.1004050. View

14.

Sedlak T, Snyder S . Bilirubin benefits: cellular protection by a biliverdin reductase antioxidant cycle. Pediatrics. 2004; 113(6):1776-82. DOI: 10.1542/peds.113.6.1776. View

15.

Kerget B, Kerget F, Kocak A, Akbas I, Araz O, Yilmazel Ucar E . Is endogenous carboxyhaemoglobin level a useful biomarker of clinical course and prognosis in COVID-19 patients?. Int J Clin Pract. 2021; 75(11):e14680. PMC: 8420518. DOI: 10.1111/ijcp.14680. View

16.

Chawla A, Ray S, Matettore A, Peters M . Arterial carboxyhaemoglobin levels in children admitted to PICU: A retrospective observational study. PLoS One. 2019; 14(3):e0209452. PMC: 6405068. DOI: 10.1371/journal.pone.0209452. View

17.

Melley D, Finney S, Elia A, Lagan A, Quinlan G, Evans T . Arterial carboxyhemoglobin level and outcome in critically ill patients. Crit Care Med. 2007; 35(8):1882-7. DOI: 10.1097/01.CCM.0000275268.94404.43. View

18.

Evans C, Orf K, Horvath E, Levin M, de la Fuente J, Chakravorty S . Impairment of neutrophil oxidative burst in children with sickle cell disease is associated with heme oxygenase-1. Haematologica. 2015; 100(12):1508-16. PMC: 4666326. DOI: 10.3324/haematol.2015.128777. View

19.

Ryter S, Choi A . Heme oxygenase-1/carbon monoxide: from metabolism to molecular therapy. Am J Respir Cell Mol Biol. 2009; 41(3):251-60. PMC: 2742746. DOI: 10.1165/rcmb.2009-0170TR. View

20.

Barker S, Curry J, Redford D, Morgan S . Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study. Anesthesiology. 2006; 105(5):892-7. DOI: 10.1097/00000542-200611000-00008. View