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Kumar N, Yadav A. Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study. JOURNAL OF MOTHER AND CHILD 2022; 26:27-34. [PMID: 35853688 PMCID: PMC10032318 DOI: 10.34763/jmotherandchild.20222601.d-22-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Birth asphyxia is a common cause of perinatal morbidity, mortality. OBJECTIVE To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. MATERIAL AND METHODS Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. RESULTS For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. CONCLUSION Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Ashu Yadav
- Department of Obstetrics and Gynecology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
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2
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DelFavero JJ, Jnah AJ, Newberry D. Glucose-6-Phosphate Dehydrogenase Deficiency and the Benefits of Early Screening. Neonatal Netw 2021; 39:270-282. [PMID: 32879043 DOI: 10.1891/0730-0832.39.5.270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy worldwide, is an insufficient amount of the G6PD enzyme, which is vital to the protection of the erythrocyte. Deficient enzyme levels lead to oxidative damage, hemolysis, and resultant severe hyperbilirubinemia. If not promptly recognized and treated, G6PD deficiency can potentially lead to bilirubin-induced neurologic dysfunction, acute bilirubin encephalopathy, and kernicterus. Glucose-6-phosphate dehydrogenase deficiency is one of the three most common causes for pathologic hyperbilirubinemia. A change in migration patterns and intercultural marriages have created an increased incidence of G6PD deficiency in the United States. Currently, there is no universally mandated metabolic screening or clinical risk assessment tool for G6PD deficiency in the United States. Mandatory universal screening for G6PD deficiency, which includes surveillance and hospital-based risk assessment tools, can identify the at-risk infant and foster early identification, diagnosis, and treatment to eliminate neurotoxicity.
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3
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Su D, Li J, Ren J, Gao Y, Li R, Jin X, Zhang J, Wang G. The relationship between serum lactate dehydrogenase level and mortality in critically ill patients. Biomark Med 2021; 15:551-559. [PMID: 33988459 DOI: 10.2217/bmm-2020-0671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: To assess the association between serum lactate dehydrogenase (LDH) levels and mortality in intensive care unit patients. Materials & methods: A total of 1981 patients in the eICU Collaborative Research Database were divided into four groups according to quartiles of LDH levels. Logistic regressions were performed. Results: Elevated LDH levels were significantly associated with higher mortality (intensive care unit mortality: Q2 vs Q1: 1.046 [0.622-1.758]; Q3 vs Q1: 1.667 [1.029-2.699]; and Q4 vs Q1: 1.760 [1.092-2.839]). Similar results persisted in patients with different acute physiology and chronic health evaluation IV scores, and with or without sepsis. Conclusion: The serum LDH level may aid in the early identification of mortality risk in critically ill patients.
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Affiliation(s)
- Dan Su
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiamei Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiajia Ren
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ya Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruohan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuting Jin
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingjing Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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4
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Elfarargy MS, Al-Ashmawy GM, Abu-Risha S, Khattab H. Novel predictor markers for early differentiation between transient tachypnea of newborn and respiratory distress syndrome in neonates. Int J Immunopathol Pharmacol 2021; 35:20587384211000554. [PMID: 33722097 PMCID: PMC7970176 DOI: 10.1177/20587384211000554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Neonatal Respiratory Distress Syndrome (RDS) and Transient Tachypnea of newborn
(TTN) are common similar neonatal respiratory diseases. Study the early
predictor markers in differentiation between TTN and RDS in neonates. A
prospective case control study which was done in Neonatal Intensive Care Unit
(NICU) of Tanta University Hospital (TUH) from September 2016 to March 2018.
Three groups of neonates were included in the study: RDS group (45 neonates),
TTN group (45 neonates), and control group (45 healthy neonates). There were
statistically significant difference (SSD) between our studied three groups as
regard serum Malondialdehyde (MDA), Superoxide dismutase SOD, Lactate
dehydrogenase (LDH), and blood PH and P-values were 0.001* for
these comparative parameters. The ROC curve of RDS cases revealed that the serum
MDA Cut off, sensitivity and specificity were 1.87 mmol/L, 98%, 96%,
respectively which had the highest sensitivity and specificity followed by the
serum SOD then the serum LDH and lastly the blood PH while in TTN cases, the
serum MDA Cut off, sensitivity and specificity were 0.74 mmol/L, 96%, 93%,
respectively then the serum SOD then the serum LDH and lastly the blood PH.
Serum MDA, SOD, LDH, and PH had a beneficial role as early predictors in
differentiation between TTN and RDS in neonates.
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Affiliation(s)
| | - Ghada M Al-Ashmawy
- Department of Biochemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Sally Abu-Risha
- Department of Pharmacology& Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Haidy Khattab
- Department of Physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
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5
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Ahmed E, Algebaly H, Abd-Elal A, Kaffas R. Predictive value of serum lactate dehydrogenase in diagnosis of septic shock in critical pediatric patients: A cross-sectional study. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.316674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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7
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Van Anh TN, Kiem Hao T, Huu Hoang H. <p>The Role of Plasma Lactate Dehydrogenase Testing in the Prediction of Severe Conditions in Newborn Infants: A Prospective Study</p>. RESEARCH AND REPORTS IN NEONATOLOGY 2020. [DOI: 10.2147/rrn.s254500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Halvorsen CP, Olson L, Araújo AC, Karlsson M, Nguyễn TT, Khu DTK, Le HTT, Nguyễn HTB, Winbladh B, Russom A. A rapid smartphone-based lactate dehydrogenase test for neonatal diagnostics at the point of care. Sci Rep 2019; 9:9301. [PMID: 31243323 PMCID: PMC6595069 DOI: 10.1038/s41598-019-45606-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/07/2019] [Indexed: 11/09/2022] Open
Abstract
There is a growing recognition of the importance of point-of-care tests (POCTs) for detecting critical neonatal illnesses to reduce the mortality rate in newborns, especially in low-income countries, which account for 98 percent of reported neonatal deaths. Lactate dehydrogenase (LDH) is a marker of cellular damage as a result of hypoxia-ischemia in affected organs. Here, we describe and test a POC LDH test direct from whole blood to provide early indication of serious illness in the neonate. The sample-in-result-out POC platform is specifically designed to meet the needs at resource-limited settings. Plasma is separated from whole blood on filter paper with dried-down reagents for colorimetric reaction, combined with software for analysis using a smartphone. The method was clinically tested in newborns in two different settings. In a clinical cohort of newborns of Stockholm (n = 62) and Hanoi (n = 26), the value of R using Pearson's correlation test was 0.91 (p < 0.01) and the R2 = 0.83 between the two methods. The mean LDH (±SD) for the reference method vs. the POC-LDH was 551 (±280) U/L and 552 (±249) U/L respectively, indicating the clinical value of LDH values measured in minutes with the POC was comparable with standardized laboratory analyses.
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Affiliation(s)
- Cecilia Pegelow Halvorsen
- Department of clinical research and education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Neonatal Unit at Sachs' Children and Youth hospital, Stockholm, Sweden
| | - Linus Olson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam
| | | | - Mathias Karlsson
- Calmark Sweden AB, Stockholm, Sweden.,Department of Medical Sciences, Biomedical Structure and Function, Uppsala University, Uppsala, Sweden
| | - Trang Thị Nguyễn
- Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.,Research Institute for Child Health, Hanoi, Vietnam
| | - Dung T K Khu
- Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam.,Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Ha T T Le
- Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.,Research Institute for Child Health, Hanoi, Vietnam
| | - Hoa T B Nguyễn
- Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.,Research Institute for Child Health, Hanoi, Vietnam
| | - Birger Winbladh
- Department of clinical research and education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Aman Russom
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
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Patavoukas E, Åberg-Liesaho J, Halvorsen CP, Winbladh B, Wiberg-Itzel E. Relationship between various maternal conditions and lactic acid dehydrogenase activity in umbilical cord blood at birth. J Perinat Med 2018. [PMID: 28622146 DOI: 10.1515/jpm-2017-0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lactic acid dehydrogenase (LDH) is a valuable marker for some of the most important diseases in newborns and the plasma LDH activity in newborns correlates well with conditions such as asphyxia. If LDH should be considered as a useful tool also in obstetric care, key factors associated with maternal health before and during pregnancy which could affect umbilical cord LDH activity need to be known. The aims of this study were to explore relationships between selected maternal conditions and arterial lactic acid dehydrogenase activity (aLDH) in umbilical cord blood at delivery. METHODS A prospective observational study was conducted at Sodersjukhuset, Stockholm, Sweden. Included in the study were 1247 deliveries, and cord blood samples from each were analyzed for aLDH. Background, delivery and neonatal data were collected from the medical records. RESULTS Higher median values of aLDH were found (P=0.001) among women with chronic disorders not related to pregnancy but there was no increased frequency of high aLDH levels (>612 μ/L, P=0.30). No difference in aLDH was identified between infants born to women with pregnancy-related disorders compared with healthy women, neither in median values, nor in high values (>612 μ/L, P=0.95). CONCLUSION Newborn infants born to women with non-pregnancy-related chronic disorders had a somewhat higher median value of aLDH in cord blood at delivery. The influence of common maternal conditions and diseases on umbilical cord arterial LDH levels is small compared to the increase reported in fetal distress and several other critical conditions in the newborn.
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Affiliation(s)
- Evangelos Patavoukas
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
| | - Josefina Åberg-Liesaho
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
| | - Cecilia Pegelow Halvorsen
- Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.,Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Birger Winbladh
- Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.,Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Eva Wiberg-Itzel
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
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10
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Lieberman L, Spradbrow J, Keir A, Dunn M, Lin Y, Callum J. Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11-year study. Transfusion 2016; 56:2704-2711. [PMID: 27459953 DOI: 10.1111/trf.13721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) is used to treat a variety of diseases in the neonatal intensive care unit (NICU). Although audits have reported on the spectrum of IVIG use in adults, the indications and utilization in neonates has not been investigated. The objectives of this study were to describe the usage pattern of and indications for IVIG in a tertiary care NICU. STUDY DESIGN AND METHODS A retrospective chart review was performed of all neonates who received IVIG in the NICU from January 2003 to December 2013. Data collected included patient demographic features, antenatal maternal details, neonatal laboratory results, treatment details, adverse events, and patient outcome. RESULTS Thirty-seven neonates received IVIG over the 11-year period. Twenty-three (67%) were treated for hemolytic disease of the newborn (HDN); 13 treatments were ABO related, six were anti-D related, and four were for clinically significant antibodies. Fourteen (33%) were treated for non-HDN causes, including eight for septic neonates, two for neonates with necrotizing enterocolitis, two for neonates with a clinically significant antibody but without evidence of hemolysis, and two for neonates with glucose 6-phosphate dehydrogenase deficiency. A complete hemolytic workup was not performed consistently before the receipt of IVIG. CONCLUSIONS This novel assessment of IVIG use in the NICU revealed the spectrum of disease for which IVIG is ordered. This study also found that key diagnostic tests needed to confirm an immune etiology for idiopathic jaundice are not performed routinely before IVIG receipt. Neonatal transfusion-related databases are needed to carry out pragmatic clinical trials to establish better evidence-based guidelines for IVIG therapy in the NICU.
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Affiliation(s)
- Lani Lieberman
- Department of Clinical Pathology, University Health Network.,Department of Clinical Pathology, Sunnybrook Health Sciences Centre.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jordan Spradbrow
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre
| | - Amy Keir
- Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia
| | - Michael Dunn
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yulia Lin
- Department of Clinical Pathology, University Health Network.,Department of Clinical Pathology, Sunnybrook Health Sciences Centre.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Clinical Pathology, University Health Network.,Department of Clinical Pathology, Sunnybrook Health Sciences Centre.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Helliksson F, Wernerman J, Wiklund L, Rosell J, Karlsson M. The combined use of three widely available biochemical markers as predictor of organ failure in critically ill patients. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:479-85. [PMID: 27362714 DOI: 10.1080/00365513.2016.1201850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND We hypothesized that lactate dehydrogenase, LDH/albumin ratio in combination with or without magnesium (Mg(2+)) could predict organ failure in critically ill adult patients. The aim of this study was to describe a new risk index for organ failure or mortality in critically ill patients based on a combination of these routinely available biochemical plasma biomarkers. METHODS Patients ≥ 18 years admitted to the intensive care unit (ICU) were screened. Albumin and LDH were analyzed at the time of admission to ICU (n = 347). Organ failure assessed with 'Sequential Organ Failure Assessment' (SOFA) score was used, and 30-day mortality was recorded. The predictive value of the test was calculated using the areas under the receiving operating characteristic (ROC) curve. RESULTS The LDH/albumin ratio was higher in patients who developed organ failure as compared to those who did not (p < 0.001). The areas under the ROC curve were 0.77 both for prediction of multiple organ failure and for 30-day mortality. In a subgroup of patients (n = 183) admitted to ICU from the emergency department, the predictive values were 0.86 and 0.80, respectively. CONCLUSION The LDH/albumin ratio at ICU admission was associated with the development of multiple organ failure and 30-day mortality in this prospective study. The clinical value of this biomarker as a predictor of organ failure in critically ill patients is yet to be defined.
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Affiliation(s)
- Fredrik Helliksson
- a Department of Clinical Science , Intervention, and Technology, CLINTEC, Karolinska Institutet , Stockholm , Sweden ;,b Department of Anesthesiology and Intensive Care , Central Hospital , Karlstad , Sweden
| | - Jan Wernerman
- a Department of Clinical Science , Intervention, and Technology, CLINTEC, Karolinska Institutet , Stockholm , Sweden
| | - Lars Wiklund
- c Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Jon Rosell
- b Department of Anesthesiology and Intensive Care , Central Hospital , Karlstad , Sweden
| | - Mathias Karlsson
- d Department of Clinical Science and Education , Karolinska Institutet Södersjukhuset , Stockholm , Sweden ;,e Department of Clinical Chemistry , Central Hospital , Karlstad , Sweden
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