Critical Care Medicine

Skip Navigation LinksHome > March 2013 - Volume 41 - Issue 3 > Association Between Cell-Free Hemoglobin, Acetaminophen, and...
Critical Care Medicine:
doi: 10.1097/CCM.0b013e3182741a54
Clinical Investigations

Association Between Cell-Free Hemoglobin, Acetaminophen, and Mortality in Patients With Sepsis: An Observational Study*

Janz, David R. MD1; Bastarache, Julie A. MD1; Peterson, Josh F. MD, MPH2; Sills, Gillian BS1; Wickersham, Nancy BS1; May, Addison K. MD3; Roberts, L. Jackson II MD4; Ware, Lorraine B. MD1,5

Collapse Box


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.

Interventions: None.

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.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.