Nagae Masaharu, Egi Moritoki, Kubota Kenta, Makino Shohei, Mizobuchi Satoshi
Department of Anesthesiology, Kobe University Hospital, Kobe, Japan.
Korean J Anesthesiol. 2018 Feb;71(1):30-36. doi: 10.4097/kjae.2018.71.1.30. Epub 2018 Feb 1.
Hyperbilirubinemia is a common postoperative complication. Elevated direct bilirubin (D-Bil) and indirect bilirubin (I-Bil) levels are related to different pathophysiologies; therefore, their associations with outcomes also differ. However, there have been few comparative studies of such associations in postoperative patients.
This retrospective study compared the associations of postoperative D-Bil and I-Bil with outcomes. We included adult patients requiring postoperative intensive care for more than 48 hours between 2008 and 2013, except those undergoing liver operations. The number of patients was determined using a power calculation. D-Bil and I-Bil measurements were obtained on postoperative days (POD) 1 and 2. The primary outcome was defined as hospital mortality, with the number of ICU-free survival days (IFSD) at POD 28 as the secondary outcome.
The study population consisted of 1,903 patients with a mortality rate of 2.2%. D-Bil at POD 1 was significantly higher in non-survivors than survivors (P = 0.001), but I-Bil at POD 1 showed no such relation (P = 0.209). Multivariate logistic analysis indicated that higher postoperative D-Bil was independently associated with increased postoperative mortality (POD 1: adjusted odds ratio [OR] = 2.32, P < 0.001; POD 2: adjusted OR = 1.95, P < 0.001), but I-Bil showed no such relation (POD 1: P = 0.913; POD 2: P = 0.209). Increased D-Bil was independently associated with decreased IFSD at POD 28 (POD 1: adjusted coefficient = -1.54, P < 0.001; POD 2: -1.84, P < 0.001). In contrast, increased I-Bil at POD 1 was independently associated with increased IFSD at POD 28 (POD 1: adjusted coefficient = +0.39, P = 0.021; POD 2: +0.33, P = 0.080).
D-Bil indices have a higher capability than I-Bil for predicting poorer outcomes in critically ill postoperative patients.
高胆红素血症是一种常见的术后并发症。直接胆红素（D - Bil）和间接胆红素（I - Bil）水平升高与不同的病理生理过程相关；因此，它们与预后的关联也有所不同。然而，针对术后患者此类关联的比较研究较少。
这项回顾性研究比较了术后D - Bil和I - Bil与预后的关联。我们纳入了2008年至2013年间需要术后重症监护超过48小时的成年患者，但不包括接受肝脏手术的患者。使用功效计算确定患者数量。在术后第1天和第2天测量D - Bil和I - Bil。主要结局定义为医院死亡率，以术后第28天无ICU生存天数（IFSD）作为次要结局。
研究人群包括1903例患者，死亡率为2.2%。术后第1天非幸存者的D - Bil显著高于幸存者（P = 0.001），但术后第1天的I - Bil无此关系（P = 0.209）。多因素逻辑分析表明，术后较高的D - Bil与术后死亡率增加独立相关（术后第1天：调整优势比[OR] = 2.32，P < 0.001；术后第2天：调整OR = 1.95，P < 0.001），但I - Bil无此关系（术后第1天：P = 0.913；术后第2天：P = 0.209）。D - Bil升高与术后第28天IFSD减少独立相关（术后第1天：调整系数 = -1.54，P < 0.001；术后第2天： -1.84，P < 0.001）。相比之下，术后第1天I - Bil升高与术后第28天IFSD增加独立相关（术后第1天：调整系数 = +0.39，P = 0.021；术后第2天： +0.33，P = 0.080）。
在危重症术后患者中，D - Bil指标预测较差预后的能力高于I - Bil。
