The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China.
State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese People's Liberation Army General Hospital and Military Medical Postgraduate College, Beijing, China.
Int J Artif Organs. 2022 Feb;45(2):146-151. doi: 10.1177/0391398821997841. Epub 2021 Mar 8.
Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia.
We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality.
A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L ( < 0.001), with a reduction rate of 24.8%. No clinically relevant thrombosis of the extracorporeal circuit occurred during the BA treatment. The 30-day and 1-year mortality rates were 68% ( = 18) and 84% ( = 21), respectively. Multivariate analysis identified that TB level before BA treatment (odds ratio [OR] 1.010, 95% confidence interval [CI] 1.000-1.019; = 0.043) was an independent risk factor of 30-day mortality.
BA treatment should be considered as an effective and safe method for the reduction of serum bilirubin in patients with post-cardiac-surgery severe hyperbilirubinemia. Patients with higher TB level before BA treatment had a relatively increased risk of 30-day mortality. Further studies are needed to evaluate the timing of BA for severe hyperbilirubinemia after cardiac surgery.
心脏手术后出现严重高胆红素血症会增加住院期间和 1 年的死亡率。本研究旨在分析心脏手术后严重高胆红素血症患者应用胆红素吸附（BA）的安全性和有效性。
我们回顾性纳入了 2015 年 1 月至 2018 年 12 月期间因心脏手术后严重高胆红素血症在我院接受 BA 治疗的患者。以血清胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶的变化，以及 30 天和 1 年死亡率为观察终点。采用单因素和多因素分析确定患者 30 天死亡率的危险因素。
共纳入 25 例患者，44 次 BA 治疗。1 次 BA 治疗使总胆红素（TB）浓度从 431.65±136.34μmol/L 降至 324.83±129.44μmol/L（ < 0.001），降低率为 24.8%。在 BA 治疗过程中，体外循环无临床相关血栓形成。30 天和 1 年死亡率分别为 68%（ = 18）和 84%（ = 21）。多因素分析显示，BA 治疗前 TB 水平（比值比[OR] 1.010，95%置信区间[CI] 1.000-1.019； = 0.043）是 30 天死亡率的独立危险因素。
BA 治疗可作为心脏手术后严重高胆红素血症患者降低血清胆红素的有效且安全的方法。BA 治疗前 TB 水平较高的患者，30 天死亡率的相对风险增加。需要进一步研究评估心脏手术后严重高胆红素血症时 BA 的应用时机。
