Faculty Collaboration Database

The association of serum bilirubin levels on the outcomes of severe sepsis. J Intensive Care Med 2015 Jan;30(1):23-9

Date

06/12/2013

Pubmed ID

23753252

DOI

10.1177/0885066613488739

Scopus ID

2-s2.0-84916897897 (requires institutional sign-in at Scopus site)   65 Citations

Abstract

PURPOSE: Admission serum bilirubin levels have been incorporated into severity of illness scoring systems in critical illness as a marker of liver dysfunction. The purpose of our study is to determine the independent association of serum bilirubin with mortality in severe sepsis and septic shock.

METHODS: We conducted a retrospective study of adult patients admitted with severe sepsis and septic shock. We excluded patients with a prior history of liver disease. We identified the highest serum bilirubin within 72 hours of admission and stratified bilirubin levels into ≤1 mg/dL (normal), 1.1 to 2 mg/dL (abnormal up to 2 mg/dL), and >2 mg/dL. We sought to determine the independent association of hyperbilirubinemia with mortality and length of intensive care unit stay in persons with severe sepsis and septic shock.

RESULTS: A total of 251 patients met criteria for severe sepsis. In all, 200 patients had a bilirubin of <1 mg/dL, and 51 had a bilirubin of >1 mg/dL. Of these 51, 12 had a bilirubin >2 mg/dL. Mortality was 12%, 24%, and 42% in persons with a bilirubin ≤1, 1.1 to 2, and >2 mg/dL, respectively. Compared to those with a bilirubin ≤ 1 mg/dL, adjusted odds of mortality in patients were 3.85 (95% confidence interval [CI] 1.21-12.2) and 9.85 (95% CI 1.92-50.5) times higher in persons with bilirubin levels between 1.1 and 2 and >2 mg/dL, respectively.

CONCLUSION: After multivariable adjustment for potential confounding factors, elevated serum bilirubin levels within 72 hours of admission are associated with an increased risk of mortality in patients with severe sepsis and septic shock. Prospective studies are warranted to further validate our findings.

Author List

Patel JJ, Taneja A, Niccum D, Kumar G, Jacobs E, Nanchal R

Authors

Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of Wisconsin
Jayshil Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin
Amit Taneja MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Bilirubin
Biomarkers
Female
Hospital Mortality
Humans
Hyperbilirubinemia
Intensive Care Units
Length of Stay
Liver Failure, Acute
Male
Patient Admission
Predictive Value of Tests
Retrospective Studies
Sepsis
Wisconsin