Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis.
Hypoxic hepatitis (HH) is the most frequent cause of acute liver injury in critically ill patients. No clinical data exist about new onset of jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of jaundice in critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of jaundice during the course of HH. Individuals with preexisting jaundice or liver cirrhosis at the time of admission (n = 31) were excluded from analysis. Jaundice was diagnosed in patients with plasma total bilirubin levels >3 mg/dL. One-year-survival, infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of jaundice was 6 days (interquartile range, 3-8). Patients who developed jaundice (group 1) needed vasopressor treatment (P < 0.05), renal replacement therapy (P < 0.05), and mechanical ventilation (P < 0.05) more often and had a higher maximal administered dose of norepinephrine (P < 0.05), compared to patients without jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P < 0.05). Occurrence of jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P < 0.05). In particular, infections as well as renal and GI complications occurred more frequently in group 1 during follow-up.


CONCLUSIONS
Jaundice is a common finding during the course of HH. It leads to an increased rate of complications and worse outcome in patients with HH.
Intensive Care Unit 13h1, Department of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
Bernhard
B
Jäger
Andreas
A
Drolz
Barbara
B
Michl
Peter
P
Schellongowski
Andja
A
Bojic
Miriam
M
Nikfardjam
Christian
C
Zauner
Gottfried
G
Heinz
Michael
M
Trauner
Valentin
V
Fuhrmann
D000368:Aged; D001663:Bilirubin / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006505:Hepatitis / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000503:physiopathology; D019934:International Normalized Ratio; D007511:Ischemia / Q000209:etiology*; D007565:Jaundice / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000627:therapeutic use; D011014:Pneumonia / Q000209:etiology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D001663:Bilirubin; D009638:Norepinephrine