• Akinori Maeda, Anis Chaba, Ryota Inokuchi, Dinesh Pandey, Sofia Spano, Atthaphong Phongphithakchai, Yukiko Hikasa, Nuttapol Pattamin, Glenn Eastwood, Hossein Jahanabadi, Siven Seevanayagam, Andrew Motley, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia; Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 1; 38 (10): 222122302221-2230.

ObjectivesCarboxyhemoglobin (CO-Hb) is a marker of hemolysis and inflammation, both risk factors for cardiac surgery-associated AKI (CSA-AKI). However, the association between CO-Hb and CSA-AKI remains unknown.DesignA retrospective cohort study.SettingTertiary university-affiliated metropolitan hospital: single center.ParticipantsAdult on-pump cardiac surgery patients from July 2014 to June 2022 (N = 1,698).InterventionsNone.Measurements And Main ResultsPatients were stratified into quartiles based on CO-Hb levels at intensive care unit (ICU) admission. A progressive increased risk of CSA-AKI was observed with higher CO-Hb levels at ICU admission. On multivariable logistic regression analysis, the highest quartile (CO-Hb ≥ 1.4%) showed an independent association with the occurrence of CSA-AKI (odds ratio 1.45 compared to the lowest quartile [CO-Hb < 1.0%], 95% CI 1.023-2.071; p = 0.038). Compared to patients with CO-Hb <1.4%, patients with CO-Hb ≥ 1.4% at ICU admission had significantly higher postoperative creatinine (135 vs 116 μmol/L, p < 0.001), higher rates of postoperative RRT (6.7% vs 2.3%, p < 0.001) and AKI (p < 0.001) on univariable analysis and shorter time to event for AKI or death (p < 0.001).ConclusionsCO-Hb ≥ 1.4% at ICU admission is an independent risk factor for CSA-AKI, which is easily obtainable and available on routine arterial blood gas measurements. Thus, CO-Hb may serve as a practical and biologically logical biomarker for risk stratification and population enrichment in trials of CSA-AKI prevention.Copyright © 2024 Elsevier Inc. All rights reserved.

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