title: Hyperbilirubinemia: a risk factor for infection in the surgical intensive care unit.
abstract: BACKGROUND
  Hyperbilirubinemia in intensive care unit (ICU) patients is common. We hypothesized that hyperbilirubinemia in the surgical ICU predisposes patients to infection.
  
  
  METHODS
  Patients with bilirubin < or = 3 mg/dL were compared to patients with bilirubin > 3 mg/dL. We then compared the low bilirubin patients to high bilirubin patients who developed infection after their hyperbilirubinemia.
  
  
  RESULTS
  There were 1,620 infections in 5,712 patients with low bilirubin (28%), compared with 284 in 409 patients in the high bilirubin group (69%, P < .001). After removing the patients in whom hyperbilirubinemia developed after infection, we found infection in 156 of 281 remaining patients (56%, P < .001). This group had a 3-fold increased risk of infection compared with low bilirubin (odds ratio [OR] 3.17, 95% confidence interval [CI] 2.48-4.03, P < .001).
  
  
  CONCLUSIONS
  There is an increased susceptibility to infection among jaundiced surgical ICU (SICU) patients that persists even when sepsis-related hyperbilirubinemia patients are excluded.
authors.affiliation: Department of Surgery, Henry Ford Hospital, Detroit, MI, USA. efield1@hfhs.org
authors.forename: Erin
authors.initials: E
authors.lastname: Field
authors.forename: H Mathilda
authors.initials: HM
authors.lastname: Horst
authors.forename: Ilan S
authors.initials: IS
authors.lastname: Rubinfeld
authors.forename: Craig F
authors.initials: CF
authors.lastname: Copeland
authors.forename: Usman
authors.initials: U
authors.lastname: Waheed
authors.forename: Jack
authors.initials: J
authors.lastname: Jordan
authors.forename: Aaron
authors.initials: A
authors.lastname: Barry
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications*; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors