title: The association of serum bilirubin levels on the outcomes of severe sepsis.
abstract: OBJECTIVE
  Admission serum bilirubin levels have been incorporated into severity of illness scoring systems in critical illness as a marker of liver dysfunction. The purpose of our study is to determine the independent association of serum bilirubin with mortality in severe sepsis and septic shock.
  
  
  METHODS
  We conducted a retrospective study of adult patients admitted with severe sepsis and septic shock. We excluded patients with a prior history of liver disease. We identified the highest serum bilirubin within 72 hours of admission and stratified bilirubin levels into ≤1 mg/dL (normal), 1.1 to 2 mg/dL (abnormal up to 2 mg/dL), and >2 mg/dL. We sought to determine the independent association of hyperbilirubinemia with mortality and length of intensive care unit stay in persons with severe sepsis and septic shock.
  
  
  RESULTS
  A total of 251 patients met criteria for severe sepsis. In all, 200 patients had a bilirubin of <1 mg/dL, and 51 had a bilirubin of >1 mg/dL. Of these 51, 12 had a bilirubin >2 mg/dL. Mortality was 12%, 24%, and 42% in persons with a bilirubin ≤1, 1.1 to 2, and >2 mg/dL, respectively. Compared to those with a bilirubin ≤ 1 mg/dL, adjusted odds of mortality in patients were 3.85 (95% confidence interval [CI] 1.21-12.2) and 9.85 (95% CI 1.92-50.5) times higher in persons with bilirubin levels between 1.1 and 2 and >2 mg/dL, respectively.
  
  
  CONCLUSIONS
  After multivariable adjustment for potential confounding factors, elevated serum bilirubin levels within 72 hours of admission are associated with an increased risk of mortality in patients with severe sepsis and septic shock. Prospective studies are warranted to further validate our findings.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Taneja
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Niccum
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacobs
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA rnanchal@mcw.edu.
authors.forename: Rahul
authors.initials: R
authors.lastname: Nanchal
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood* / Q000401:mortality; D007362:Intensive Care Units; D007902:Length of Stay; D017114:Liver Failure, Acute / Q000097:blood* / Q000401:mortality; D008297:Male; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000401:mortality / Q000628:therapy; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: epidemiology; hyperbilirubinemia; septic shock; severe sepsis