Postoperative hyperbillirubinemia is, an independent predictor of longterm outcomes after cardiopulmonary bypass
Postoperative hyperbillirubinemia is, an independent predictor of longterm outcomes after cardiopulmonary bypass
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DOI：
10.1016/j.jamcollsurg.2007.11.021
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发表时间：
2008-04-01
影响因子：
5.2
通讯作者：
Perez-Tamayo, R. Anthony
中科院分区：
文献类型：
--
作者：
Kraev, Alexander I.;Torosoff, Mikhail T.;Perez-Tamayo, R. Anthony
背景：两项针对体外循环 (CPB) 患者长达 10 年的研究表明，术后高胆红素血症的发生率为 25% 至 35%，与院内发病率和死亡率增加相关。这种并发症的长期后果尚不清楚。 研究设计：审查了 CPB 患者的医疗记录。死亡率是通过国家死亡指数确定的。比例风险决定了 CPB 后生存的重要因素。逻辑回归描绘了高胆红素血症的预测因素。 Kaplan-Meier 和 Mantel-Cox 对数秩生存分析比较了高胆红素血症组。结果：对 826 名 (59.7%) 患者的胆红素水平进行了随访。 570 名（69.0%）患者（第 1 组）胆红素正常，184 名（22.3%）患者（第 2 组）胆红素为 1.4 至 2.8 mg/dL，72 名（8.7%）患者（第 3 组）超过 2.8 mg/dL。胆红素升高与体重指数下降、充血性心力衰竭、术前肝素、术后输血需求、出血和肾功能衰竭相关。第 2 组的院内死亡率为 4.3%，第 3 组的院内死亡率为 25.0%，而第 1 组的院内死亡率为 0.9%（p < 0.001）。第 1 组的两年粗生存率为 95.8%，第 2 组为 84.8%，第 3 组为 62.5% (p < 0.001)。长期死亡率的多变量预测因素包括年龄较大、中风病史、急诊手术、体外循环时间延长、呼吸衰竭和胆红素升高。与第 1 组的生存率相比，第 2 组的 2 年生存率下降了 1.7 倍（95% CI 0.9 至 3.0；p = 0.09），第 3 组的生存率下降了 3.8 倍（95% CI 2.0 至 7.2；p < 0.001）。 结论：CPB 患者术后胆红素升高常见且致命。高胆红素血症的预测能力与呼吸衰竭相似。搭桥后高胆红素血症的原因尚不清楚，可能是多因素的。需要进行额外的前瞻性研究。
BACKGROUND: Two decade-old studies of cardiopulmonary bypass (CPB) patients documented a 25% to 35% incidence of postoperative hyperbilirubinemia, associated with increased in-hospital morbidity and mortality. Longterm consequences of this complication are unknown.STUDY DESIGN: Medical records of CPB patients were reviewed. Mortality was ascertained through the National Death Index. Proportional hazards determined important factors in post-CPB survival. Logistic regression delineated predictors of hyperbilirubinemia. Kaplan-Meier and Mantel-Cox log-rank survival analyses compared hyperbilirubinemia groups.RESULTS: Bilirubin levels were followed in 826 (59.7%) patients. Bilirubin was normal in 570 (69.0%) patients (group 1), it was 1.4 to 2.8 mg/dL in 184 (22.3%) patients (group 2), and it exceeded 2.8 mg/dL in 72 (8.7%) patients (group 3). Elevated bilirubin was associated with decreased body mass index, congestive heart failure, heparin before operation, postoperative transfusion requirement, bleeding, and renal failure. In-hospital mortality was 4.3% in group 2 and 25.0% in group 3, compared with 0.9% in group 1 (p < 0.001). Two-year crude survival was 95.8% in group 1, 84.8% in group 2, and 62.5% in group 3 (p < 0.001).Multivariable predictors of longterm mortality were older age, history of stroke, emergency operation, increased duration of cardiopulmonary bypass, respiratory failure, and elevated bilirubin. Compared with survival in group 1, there was a 1.7-fold decrease in group 2 2-year survival (95% CI 0.9 to 3.0; p = 0.09) and a 3.8-fold decrease in group 3 survival (95% CI 2.0 to 7.2; p < 0.001).CONCLUSIONS: Postoperative bilirubin elevation in CPB patients is common and deadly. The predictive power of hyperbilirubinemia is similar to that of respiratory failure. The cause of postbypass hyperbilirubinemia is unknown and is probably multifactorial. Additional prospective studies are warranted.