Hemolysis, hemolytic markers, and mortality in sepsis: a scoping review.

Abstract

Background: Despite advanced and early treatment in the intensive care unit (ICU), mortality in patients with sepsis remains high. Sepsis is often associated with hemolysis. In the clinical routine, hemolysis is often overlooked, as markers of hemolysis are often not routinely measured. Aim of this scoping literature review is to quantify the incidence and extent of hemolysis in patients with sepsis and the association with mortality.

Methods: Systematic literature search in bibliographic databases MEDLINE, EMBASE and Web of Science for sepsis and hemolysis.

Results: A total of 3382 studies underwent title-abstract screening and 169 studies were reviewed in full. There were 34 studies with a total of 27,702 patients with sepsis and reported hemolysis or hemolytic markers and clinical outcomes included in the final analyses. Mortality ranged from 5.4 to 78.6% with a mean mortality of 20.1% across all studies. A significant association between hemolysis or hemolytic markers with increased mortality was observed in nine studies.

Conclusions: Although significant associations between hemolysis and outcome in patients with sepsis were observed, hemolytic markers are not yet routinely and regularly monitored in clinical routine on the ICU. Hemolytic markers can provide information about disease severity and outcome on ICU admission and during the course of the disease. Future work should focus on identification of reliable markers of hemolysis with a potential for easy and timely measurements ideally at the patients' bedside. With an additional definition of monitoring standards, the potential of hemolysis monitoring for prognostication and therapeutic approaches will emerge.