title: Jaundice in critical illness: promoting factors of a concealed reality.
abstract: OBJECTIVE
  In critical illness, liver dysfunction (LD) is associated with a poor outcome independently of other organ dysfunctions. Since strategies to support liver function are not available, a timely and accurate identification of factors promoting LD may lead to prevention or attenuation of its consequences. The aim of this study was to assess risk factors for LD in critically ill patients.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  A multidisciplinary intensive care unit (ICU) of a university hospital.
  
  
  METHODS
  All patients consecutively admitted over a 6-month period.
  
  
  METHODS
  None.
  
  
  RESULTS
  LD was defined as serum bilirubin levels >or=2 mg/dl and lasting for at least 48 h. Out of 283 patients, 141 matched inclusion criteria. Forty-four patients (31.2%) showed LD (LD group), while 97 (68.8%) were included in control group (C group). A binomial analysis showed that LD occurrence was associated with moderate (odds ratio [OR] 3.11; p=0.04) and severe shock (OR 3.46; p= 0.05), sepsis (OR 3.03; p=0.04), PEEP ventilation (OR 4.25; p=0.006), major surgery (OR 4.03; p=0.03), and gram-negative infections (OR 3.94; p=0.002). In stepwise multivariate analysis, the single independent predictive factors of LD resulted in severe shock (p=0.002), sepsis (p=0.03), PEEP ventilation (p=0.04), and major surgery (p=0.05).
  
  
  CONCLUSIONS
  In critically ill patients jaundice is common, and severe shock states, sepsis, mechanical ventilation with PEEP and major surgery are critical risk factors for its onset. Since there is no specific treatment, prompt resuscitation, treatment of sepsis and meticulous supportive care will likely reduce its incidence and severity.
authors.affiliation: Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy. nbrienza@rianima.uniba.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Brienza
authors.affiliation: Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Dalfino
authors.affiliation: Anaesthesia and Intensive Care Unit, University of Foggia, Foggia, Italy.
authors.forename: Gilda
authors.initials: G
authors.lastname: Cinnella
authors.affiliation: Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Diele
authors.affiliation: Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruno
authors.affiliation: Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Fiore
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007565:Jaundice / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011446:Prospective Studies; D012151:Resuscitation; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012769:Shock / Q000150:complications; D013514:Surgical Procedures, Operative / Q000009:adverse effects