title: Hyperbilirubinemia after cardiac surgery: An observational study.
abstract: BACKGROUND
  We aimed to assess the incidence and perioperative risk factors for hyperbilirubinemia after cardiac surgery, and determine its influence on early operative outcome.
  
  
  METHODS
  This prospective observational study was conducted on 476 patients who underwent cardiac surgical procedures from January 2014 to March 2014. Postoperative hyperbilirubinemia was defined as serum total bilirubin >2.0 mg dL(-1).
  
  
  RESULTS
  The overall incidence of postoperative hyperbilirubinemia was 25% (119 patients). Patients undergoing valve repair or replacement had the highest incidence of hyperbilirubinemia (36.2%), followed by coronary artery bypass grafting with concomitant valve surgery (34.1%), congenital heart surgery (23.1%), and coronary artery bypass alone (12.7%). Postoperative hyperbilirubinemia was associated with increased duration of inotropic support (p = 0.0001), mechanical ventilation (p = 0.0001), intensive care unit stay (p = 0.001), hospital stay (p = 0.006), and mortality (p = 0.014). The perioperative factors associated with postoperative hyperbilirubinemia were increased preoperative bilirubin level (p < 0.0001), preoperative prothrombin time (p < 0.0001), cardiopulmonary bypass time (p = 0.028), aortic crossclamp time (p = 0.004), and blood transfusion units (p = 0.0001).
  
  
  CONCLUSIONS
  Postoperative hyperbilirubinemia is common in patients undergoing cardiopulmonary bypass and is associated with high hospital mortality. The factors associated with its occurrence are increased preoperative bilirubin level, preoperative prothrombin time, cardiopulmonary bypass time, aortic crossclamp time, and blood transfusion units. Persistent hyperbilirubinemia is associated with a worse outcome than early transient hyperbilirubinemia.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India realpranav@yahoo.com.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India.
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Ananthanarayanan
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India.
authors.forename: Nikunj
authors.initials: N
authors.lastname: Vaidhya
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India.
authors.forename: Amber
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Department of Research, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India.
authors.forename: Komal
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Research, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India.
authors.forename: Ramanand
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011517:Prothrombin Time; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: Cardiac surgical procedures; Cardiopulmonary bypass; Hyperbilirubinemia; Jaundice; Liver function tests; Risk factors