Increased mortality in critically ill patients with mild or moderate hyperbilirubinemia.
Increased bilirubin concentrations may be related to outcome, but this has not been well studied. We evaluated the relationship between total serum bilirubin levels and outcome in critically ill patients.



Data were analyzed from adult critically ill patients included in a 1-day international prevalence study after excluding those with an obvious underlying cause of hyperbilirubinemia.



Serum bilirubin concentrations were >1 mg/dL in 2803 (31%) of 8973 patients, and these patients had higher mortality rates than patients with lower bilirubin concentrations (30% vs 21%, P<.01). For serum bilirubin values of 1.1-6 mg/dL, there was a linear increase in crude mortality (R2=0.96), with the highest hospital mortality (42%) in patients with bilirubin concentrations between 3.7 and 6.0 mg/dL. There was no further increase in the mortality rates for patients with bilirubin concentrations >6 mg/dL. A serum bilirubin concentration >1 mg/dL was an independent risk factor for mortality in multilevel analysis.



Hyperbilirubinemia without a recognized cause was common and independently associated with increased mortality. There was a linear correlation of mortality with bilirubin concentration for values between 1 and 6 mg/dL but not for higher values.
Intensive Care Department, Brugmann University Hospital, Brussels, Belgium.
Charalampos
C
Pierrakos
Internal Medicine Department, University Hospital of Patras, Greece.
Dimitrios
D
Velissaris
Intensive Care Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland.
Peter
P
Felleiter
Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy.
Massimo
M
Antonelli
Hospices Civils de Lyon, Service d'Hygiène, Epidémiologie et Prévention, Unité Epidémiologie et Biomarqueurs de l'Infection, Lyon, France.
Philippe
P
Vanhems
Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany.
Yasser
Y
Sakr
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: jlvincent@intensive.org.
Jean-Louis
JL
Vincent
D001530:Belgium / Q000453:epidemiology; D001663:Bilirubin / Q000097:blood; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors
D001663:Bilirubin
Bilirubin; Intensive care; Mortality