title: Discriminatory performance of positive urine hemoglobin for detection of significant hemolysis in patients with continuous-flow left ventricular assist devices.
abstract: Serum lactate dehydrogenase (LDH) is the standard measure for detection of hemolysis and thus surveillance for device thrombosis in patients on continuous-flow left ventricular assist device (CF-LVAD) support. Significant hemolysis has been defined as LDH ≥600 IU/L. However, LDH testing requires phlebotomy, precluding frequent home monitoring. Simple dipstick urinalysis (UA) for urine hemoglobin (U-Hb) overcomes this limitation. This study correlated U-Hb and LDH levels and evaluated the performance of UA for detection of significant hemolysis in patients with CF-LVADs.
  
  
  
  U-Hb and LDH were measured concurrently 956 times in 221 patients with CF-LVADs. Statistics were computed to determine accuracy of UA in detecting LDH ≥600 IU/L, with a positive result being any detected U-Hb. All analyses were performed with and without excluding for 1) conditions associated with tissue damage, which are known to increase LDH, and 2) suspected or confirmed urinary tract infections or hematuria, which are known to cause hemoglobinuria for reasons other than hemolysis.
  
  
  
  Mean LDH for absent/mild/severe U-Hb was 360 IU/L/467 IU/L IU/L/777 IU/L without exclusions, 354 IU/L/444 IU/L IU/L/651 IU/L after excluding non-hemolytic LDH elevations, 370 IU/L/513 IU/L IU/L/1,357 IU/L after excluding urinary tract infections and hematuria, and 367 IU/L/470 IU/L IU/L/1,217 IU/L when both exclusions applied (all p < 0.001). Absent U-Hb had a negative predictive value for LDH ≥600 IU/L of >90% for all analyses.
  
  
  
  Serum LDH is significantly associated with U-Hb levels. Absence of U-Hb appears to efficiently exclude significant hemolysis in patients with CF-LVADs. Because it can be performed by patients at home, hemoglobinuria monitoring may enable more intense surveillance and earlier diagnosis of device thrombosis.
authors: Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Michael V
authors: MV
authors: Gavalas
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors: Alexander
authors: A
authors: Breskin
authors: Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Melana
authors: M
authors: Yuzefpolskaya
authors: Division of Hematology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Andrew
authors: A
authors: Eisenberger
authors: Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Francesco
authors: F
authors: Castagna
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors: Ryan T
authors: RT
authors: Demmer
authors: Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Margaret
authors: M
authors: Flannery
authors: Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: A Reshad
authors: AR
authors: Garan
authors: Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Koji
authors: K
authors: Takeda
authors: Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Hiroo
authors: H
authors: Takayama
authors: Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Yoshifumi
authors: Y
authors: Naka
authors: Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York.
authors: Veli K
authors: VK
authors: Topkara
authors: Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York. Electronic address: pcc2001@columbia.edu.
authors: Paolo C
authors: PC
authors: Colombo
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000652:urine; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy* / Q000652:urine; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006454:Hemoglobins / Q000378:metabolism*; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000652:urine*; D016482:Urinalysis; D050477:Urofollitropin
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D050477:Urofollitropin; D007770:L-Lactate Dehydrogenase
keywords: advanced heart failure; mechanical support; pump thrombosis; thrombus; ventricular assist device