Incidence, Clinical Characteristics and Outcomes of Early Hyperbilirubinemia in Critically ill Patients - Insights From The Mars Study.
Juschten J., Bos LDJ., de Grooth H-J., Beuers U., Girbes ARJ., Juffermans NP., Loer SA., van der Poll T., Cremer OL., Bonten MJM., Schultz MJ., Tuinman PR., MARS consortium None.
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.