Bilirubin adsorption versus plasma exchange for hyperbilirubinemia in patients after cardiac surgery: a retrospective study.
Bilirubin adsorption versus plasma exchange for hyperbilirubinemia in patients after cardiac surgery: a retrospective study.
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DOI：
10.1186/s13019-021-01622-8
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发表时间：
2021-08-23
影响因子：
1.6
通讯作者：
Wang DJ
中科院分区：
文献类型：
--
作者：
Pan K;Zhang H;Zhong K;Zhang HT;Li ZS;Chen Z;Gu SP;Xie M;Pan T;Cao HL;Wang DJ
心脏手术后高胆红素血症会增加院内死亡率，并与预后不良相关。我们目前的研究旨在比较胆红素吸附（BA）和血浆交换（PEX）对心脏手术后高胆红素血症患者的疗效。我们回顾性纳入了2015年至2020年在我中心因心脏术后严重高胆红素血症而接受BA治疗或PEX治疗的患者。我们收集了治疗前后的尿液和肝功能检查结果，并比较了两个治疗组之间的院内死亡率和发病率。本研究共有 56 名患者入组：14 名患者接受 BA 治疗，42 名患者接受 PEX 治疗。与PEX组相比，BA组的总胆红素（p = 0.016）和直接胆红素（p = 0.036）水平显着降低。全组院内死亡率为85.7%（48/56），其中BA组死亡率低于PEX组（71.4% vs. 90.5%，p = 0.078）。 BA 组显示出更好的循环支持，包括 IABP 风险较低（21.4% vs. 52.4%，p = 0.044）、ECMO（21.4% vs. 50.0%，p = 0.061）、重新插管（64.3% vs. 40.5%，p = 0.122）和心室风险心律失常（64.3% vs. 45.2%，p = 0.217）。在匹配队列中，BA 治疗组的院内死亡率仍低于 PEX 治疗组（71.4% vs. 100%，p = 0.049）。与PEX治疗相比，BA治疗对高胆红素血症患者具有更高的胆红素清除能力，可以降低死亡率和不良临床结果的风险。对于总胆红素或直接胆红素水平较高的患者，BA 治疗应被视为有效的治疗方法。
Hyperbilirubinemia after cardiac surgery increases in-hospital mortality and is associated with poor prognosis. Our present study aimed to compare the efficacy of bilirubin adsorption (BA) and plasma exchange (PEX) in patients with hyperbilirubinemia after cardiac surgery. We retrospectively included patients who underwent BA treatment or PEX treatment due to severe hyperbilirubinemia after cardiac surgery at our center from 2015 to 2020. We collected results from urine and liver function tests before and after treatment and compared the in-hospital mortality and morbidity between the two treatment groups. A total of 56 patients were enrolled in this study: 14 patients received BA treatment, and 42 patients received PEX treatment. Compared to the PEX group, the BA group exhibited a statistically significant reduction in total bilirubin (p = 0.016) and direct bilirubin (p = 0.036) levels. The in-hospital mortality was 85.7% (48/56) in the whole group, and the BA group had a lower mortality than the PEX group (71.4% vs. 90.5%, p = 0.078). The BA group showed better circulatory support, including lower risks of IABP (21.4% vs. 52.4%, p = 0.044), ECMO (21.4% vs. 50.0%, p = 0.061), reintubation (64.3% vs. 40.5%, p = 0.122) and ventricular arrhythmias (64.3% vs. 45.2%, p = 0.217). The in-hospital mortality was still lower in the BA treatment group than in the PEX treatment group (71.4% vs. 100%, p = 0.049) in the matched cohort. Compared to PEX treatment, BA treatment had a higher bilirubin removal ability in patients with hyperbilirubinemia and could reduce the mortality and risks of poor clinical outcomes. BA treatment should be considered an effective treatment method for patients with higher total bilirubin or direct bilirubin levels.
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影响因子：
3.4
作者：
WELBOURN, N;MELROSE, DG;MOSS, DW
通讯作者：
MOSS, DW
DOI：
10.1186/cc691
发表时间：
2000
期刊：
Critical care (London, England)
影响因子：
--
作者：
Hosotsubo KK;Nishimura M;Nishimura S
通讯作者：
Nishimura S
影响因子：
2.9
作者：
Gregoretti, S
通讯作者：
Gregoretti, S
影响因子：
0.9
作者：
Lee, J. Y.;Kim, S. B.;Lee, S. G.
通讯作者：
Lee, S. G.
影响因子：
4.6
作者：
Steiner, C;Sen, S;Jalan, R
通讯作者：
Jalan, R