title: Early Hepatic Dysfunction Is Associated with a Worse Outcome in Patients Presenting with Acute Respiratory Distress Syndrome: A Post-Hoc Analysis of the ACURASYS and PROSEVA Studies.
abstract: BACKGROUND
  Bilirubin is well-recognized marker of hepatic dysfunction in intensive care unit (ICU) patients. Multiple organ failure often complicates acute respiratory distress syndrome (ARDS) evolution and is associated with high mortality. The effect of early hepatic dysfunction on ARDS mortality has been poorly investigated. We evaluated the incidence and the prognostic significance of increased serum bilirubin levels in the initial phase of ARDS.
  
  
  METHODS
  The data of 805 patients with ARDS were retrospectively analysed. This population was extracted from two recent multicenter, prospective and randomised trials. Patients presenting with ARDS with a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen < 150 mmHg measured with a PEEP ≥ 5 cm of water were included. The total serum bilirubin was measured at inclusion and at days 2, 4, 7 and 14. The primary objective was to analyse the bilirubin at inclusion according to the 90-day mortality rate.
  
  
  RESULTS
  The 90-day mortality rate was 33.8% (n = 272). The non-survivors were older, had higher Sepsis-related Organ Failure Assessment (SOFA) score and were more likely to have a medical diagnosis on admission than the survivors. At inclusion, the SOFA score without the liver score (10.3±2.9 vs. 9.0±3.0, p<0.0001) and the serum bilirubin levels (36.1±57.0 vs. 20.5±31.5 μmol/L, p<0.0001) were significantly higher in the non-survivors than in the survivors. Age, the hepatic SOFA score, the coagulation SOFA score, the arterial pH level, and the plateau pressure were independently associated with 90-day mortality in patients with ARDS.
  
  
  CONCLUSIONS
  Bilirubin used as a surrogate marker of hepatic dysfunction and measured early in the course of ARDS was associated with the 90-day mortality rate.
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dizier
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.affiliation: Hospices Civils de Lyon, Hôpital Henri Gabrielle, CClin Sud Est, 69230, Saint Genis Aval, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Ayzac
authors.affiliation: Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Réanimation médicale et Surveillance Continue, 69004, Lyon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Richard
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lehingue
authors.affiliation: Unité d'Aide Méthodologique à la Recherche clinique DRRC/AP-HM, Laboratoire de Santé Publique Faculté de Médecine, 13005, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.affiliation: Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Réanimation médicale et Surveillance Continue, 69004, Lyon, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Guerin
authors.affiliation: Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, 13015, Marseille, France.|Aix-Marseille Université, Faculté de médecine, URMITE UMR CNRS 7278, 13005, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D001663:Bilirubin; D010100:Oxygen