Cardiothoracic & vascular anaesthesia
Exploring carboxyhemoglobin as a predictive marker of hemolysis-related cardiac surgery-associated acute kidney injury (CSA-AKI)
Authors' conclusion
Immediate postoperative COHb is a potential predictor of CSA-AKI and reflects the intensity of CPB-related hemolysis.
Study context
- Population
- Adults undergoing on-pump cardiac surgery over a 4-month period86 (32.8%) developed CSA-AKI
- Participants
- 262 adults
- Exposure
- Carboxyhemoglobin (COHb) vs other hemolysis-related biomarkers for predicting CSA-AKI
- Outcome
- Performance of COHb to predict CSA-AKI (KDIGO criteria) compared with other hemolysis-related biomarkers
- Follow-up
- Immediately postoperatively
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Discrimination for CSA-AKI (ROC analysis)
| Group | AUC | AUC 95% CI | Sensitivity (cut-off 1.25%) | Specificity (cut-off 1.25%) |
|---|---|---|---|---|
| COHb | 0.65 | 0.58-0.72 | 0.58 | 0.65 |
COHb
AUC0.65
AUC 95% CI0.58-0.72
Sensitivity (cut-off 1.25%)0.58
Specificity (cut-off 1.25%)0.65
Observational data: associations, not effects.
Further findings
Independent association of immediate postoperative COHb with CSA-AKI (multivariable logistic regression)
| OR (95% CI) | ||
|---|---|---|
| COHbTogether with age, preoperative AF and CPB duration | 1.89 (1.02–3.49) | |
| 0.20.5125Odds ratio (log scale) |
Clinical outcomes by COHb ≥1.25%
- Higher COHb associated with increased incidence and severity of AKI and longer mechanical ventilation
- Not associated with vasopressor duration, ICU LOS, ICU mortality or postoperative AF
Correlation of COHb with cardiopulmonary bypass (CPB) duration
- COHb correlated positively with CPB duration
Original publication
Exploring carboxyhemoglobin as a predictive marker of hemolysis-related CSA-AKI. J Clin Anesth. Published 10 June 2026. doi:10.
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