Skip to main content
  • Poster presentation
  • Open access
  • Published:

Is hemoglobin concentration affected by sepsis in the acute phase?

Introduction

In the acute phase of sepsis several potential mechanisms may change the hemoglobin (Hb) concentration. On the one hand, endothelial activation may lead to increased vascular permeability and fluid sequestration to the interstitium, leading to hemoconcentration. On the other hand, degradation of the glycocalyx has been reported [1]. Shedding of this carbohydrate-rich layer with an estimated thickness of 0.2 to 0.5 µm may lead to a substantial increase of the intravascular space, and thus to decrease of Hb concentration [2]. The aim of this study is to determine whether there is a decrease in Hb in the acute phase of sepsis.

Methods

In this single-center retrospective analysis we identified patients with sepsis as the primary reason for non-elective ICU admission from a standard patient database. Patients who fulfilled the international criteria of sepsis and organ failure during ICU admission were included in the sepsis group (S-group). The control group was formed by patients with other non-elective reasons for ICU admission (C-group). Exclusion criteria were (recent) bleeding, surgery in the last 6 weeks, chronic renal failure (creat >177 μmol/l, or hemodialysis), untreated chronic anemia, pregnancy, polytrauma, age <18, hematologic or metastasized malignancies, cardiac arrest, and use of bone marrow suppressive drugs. Laboratory data were collected from blood samples, prior to in-hospital i.v. fluid therapy. In order to detect a difference in Hb concentration of 0.23mmol/l, we anticipated a sample size of 283 per group, based on a standard deviation (SD) of 1.2, α = 0.05 and β = 0.8. Data are expressed as mean ± SD.

Results

We included 296 patients in the S-group and 320 in the C-group. The difference in Hb between the S-group and C-group was not significant (8.76 ± 1.18 mmol/l vs. 8.93 ± 1.16 mmol/l, P = 0.07). After correction for a number of confounders, using a multivariate regression analysis, we observed a significant difference in Hb of -0.23 mmol/l in the S-group in comparison with the C-group (P = 0.01).

Conclusion

At first presentation, prior to in-hospital i.v. fluid therapy, Hb concentration in patients with sepsis is significantly lower in comparison with controls; however, the difference is very small, without the existence of anemia.

References

  1. Steppan J, et al.: Sepsis and major abdominal surgery lead to 3 aking of the endothelial glycocalyx. J Surg Res 2011, 165: 136-141. 10.1016/j.jss.2009.04.034

    Article  PubMed  Google Scholar 

  2. van den Berg BM, et al.: The endothelial glycocalyx protects against myocardial edema. Circ Res 2003, 92: 592-594. 10.1161/01.RES.0000065917.53950.75

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Jansma, G., Buter, H., Gerritsen, R. et al. Is hemoglobin concentration affected by sepsis in the acute phase?. Crit Care 17 (Suppl 2), P10 (2013). https://doi.org/10.1186/cc11948

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc11948

Keywords