SESSION TITLE: Critical Care Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: To evaluate patterns of mortality in intensive care unit (ICU) patients according to bilirubin levels.
METHODS: We reviewed data from adult critically ill patients included in a one-day international prevalence study (EPIC II), excluding those with liver cirrhosis. Severity of illness was assessed using the SAPS II score. Multiple organ failure (MOF) was considered when there were at least two individual SOFA scores >3.
RESULTS: From a total of 9710 patients, 1641 (17%) had hyperbilirubinemia. Increasing serum bilirubin levels were associated with higher SAPS II scores (bilirubin <2 mg/dl: 35±14, bilirubin 2-6 mg/dl: 42±18, bilirubin >6 mg/dl: 47±16, p<0.001). However, when the bilirubin points were not included, the SAPS II score was lower in patients with bilirubin levels >6 mg/dl compared to patients with bilirubin 2-6 mg/dl (37±15 vs 40±17, p=0.001). Patients with bilirubin >2 mg/dl had higher ICU (30% [95%CI: 28-33] vs 17% [16-18], p<0.001) and hospital (37% [34-39] vs 23% [22-24], p<0.001) mortality rates compared to other patients. There was a linear increase in crude mortality in relation to the increase in bilirubin levels for serum bilirubin values of 0.8-3 mg/dl (p<0.01) but not for higher bilirubin levels. Interestingly, patients with very high bilirubin levels (>6 mg/dl) had lower rates of sepsis (62 vs 69%, p<0.001), MOF (64% vs 70%, p=0.01), and ICU (25% vs 30%, p=0.03) and hospital (30% vs 37%, p<0.001) mortality rates compared to patients with lower bilirubin levels (2-6 mg/dl).
CONCLUSIONS: Even mild hyperbilirubinemia is associated with an excess risk of death in critically ill patients. However, patients with very high (>6 mg/dl) bilirubin levels had lower rates of sepsis, MOF and mortality compared to patients with moderately increased bilirubin levels (2-6 mg/dl).
CLINICAL IMPLICATIONS: The increase in mortality rate is less marked in patients with the highest bilirubin concentrations.
DISCLOSURE: The following authors have nothing to disclose: Charalampos Pierrakos, Dimitris Velissaris, Thierry Gustot, Daniel Kett, Philippe Vanhems, Peter Felleiter, Ioana Grigoras, Yasser Sakr, Jean-Louis Vincent
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