title: Direct bilirubin as a prognostic biomarker in enteric fistula patients complicated with sepsis: a case-control study.
abstract: OBJECTIVE
  The objective of this study was to evaluate the predictive value of serial bilirubin determinations for mortality in enteric fistula (EF) patients complicated with sepsis.
  
  
  METHODS
  From January 1st, 2012 to January 13rd, 2013, a prospective study enrolling 162 patients was performed. Patients were divided into the survivors group (n = 119) and non-survivors group (n = 43) according to 28-day outcomes. Laboratory variables on day 0, day 3 and day 7 after admission were recorded. DB0 was defined as serum direct bilirubin (DB) value in admission, while ΔDB3 as the changes from DB3 to DB0. The definition applied to other parameters. The results were validated in an independent cohort of 116 patients.
  
  
  RESULTS
  Compared with survivors, non-survivors had significantly higher DB7 (23.1 ± 10.6 vs. 11.2 ± 1.1, P < 0.001) and procalcitonin (PCT7) (5.2 ± 2.8 vs. 1.7 ± 0.3 P = 0.006). ROC analysis showed that DB7 > 12.8 μmol/L and ΔDB7 > 7.3 μmol/L were reliable predictors (DB7: 86.4% sensitivity, 88.6% specificity (area under the curve (AUC): 0.881, P < 0.001; ΔDB7: 84.4% sensitivity, 85.1% specificity, AUC: 0.865, P < 0.001) for mortality.The combination form (DB7 > 12.8 μmol/L + ΔPCT7 < 5.3 ng/ml) had greatest predictive value (AUC: 0.894, P < 0.001). Their predictive values were confirmed in the validation cohort.
  
  
  CONCLUSIONS
  Serum direct bilirubin was a reliable predictor for mortality in enteric fistula patients, which should be paid close attention in the critical care.
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Yin
authors: Y
authors: Wu
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Jianan
authors: J
authors: Ren
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Gefei
authors: G
authors: Wang
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Guosheng
authors: G
authors: Gu
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Bo
authors: B
authors: Zhou
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Chao
authors: C
authors: Ding
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Guanwei
authors: G
authors: Li
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Song
authors: S
authors: Liu
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Xiuwen
authors: X
authors: Wu
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Jun
authors: J
authors: Chen
authors: Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
authors: Jieshou
authors: J
authors: Li
keywords: Bilirubin; abdominal sepsis; direct bilirubin; enteric fistula; predictor