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ObjectiveTo investigate the incidence, clinical characteristics and outcomes of early hyperbilirubinemia in critically ill patients.Design and settingThis is a post-hoc analysis of a prospective multicenter cohort study.PatientsPatients with measured bilirubin levels within the first 2 days after ICU admission were eligible. Patients with liver cirrhosis were excluded.EndpointsThe primary endpoint was the incidence of early hyperbilirubinemia, defined as bilirubin ≥ 33 μmol/L within 2 days after ICU admission. Secondary endpoints included clinical characteristics of patients with versus patients without early hyperbilirubinemia, and outcomes up to day 30.ResultsOf 4836 patients, 559 (11.6%) patients had early hyperbilirubinemia. Compared to patients without early hyperbilirubinemia, patients with early hyperbilirubinemia presented with higher severity of illness scores, and higher incidences of sepsis and organ failure. After adjustment for confounding variables, early hyperbilirubinemia remained associated with mortality at day 30 (odds ratio, 1.31 [95%-confidence interval 1.06-1.60]; p = 0.018). Patients with early hyperbilirubinemia and thrombocytopenia (interaction p-value = 0.005) had a higher likelihood of death within 30 days (odds ratio, 2.61 [95%-confidence interval 2.08-3.27]; p ConclusionsEarly hyperbilirubinemia occurs frequently in the critically ill, and these patients present with higher disease severity and more often with sepsis and organ failures. Early hyperbilirubinemia has an association with mortality, albeit this association was only found in patients with concomitant thrombocytopenia.

Original publication

DOI

10.1097/shk.0000000000001836

Type

Journal

Shock (Augusta, Ga.)

Publication Date

07/07/2021

Addresses

Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands: Department of Anesthesiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands: Department of Intensive Care Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands: Research VUmc Intensive Care (REVIVE) Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands: Department of Intensive Care Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands: Department of Pulmonology Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands: Department of Gastroenterology and Hepatology Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands: Division of Infectious Diseases Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands: Center for Experimental and Molecular Medicine (CEMM) OLVG hospital, Amsterdam, The Netherlands: Department of Intensive Care Medicine University Medical Center Utrecht, Utrecht, The Netherlands: Department of Intensive Care Medicine University Medical Center Utrecht, Utrecht, The Netherlands: Department of Medical Microbiology Mahidol University, Bangkok, Thailand: Mahidol-Oxford Tropical Medicine Research Unit (MORU) Mahidol University, Bangkok, Thailand: University of Oxford, Oxford, UK: Nuffield Department of Medicine.

Keywords

MARS consortium