Chen Xiaolan, Bai Ming, Sun Shiren, Chen Xiangmei
Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, Shaanxi, China.
Department of Nephrology, State Key Laboratory of Kidney Disease, Chinese People's Liberation Army General Hospital and Military Medical Postgraduate College, 28th Fuxing Road, Beijing 100853, China.
Open Med (Wars). 2021 Aug 31;16(1):1276-1285. doi: 10.1515/med-2021-0316. eCollection 2021.
The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia.
All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality.
After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration ( = 0.002) and duration of mechanical ventilation ( = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival.
Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.
本研究旨在探讨先天性心脏病（CHD）术后严重高胆红素血症患者的特征及预后。
回顾性筛选2015年1月至2018年12月在本中心接受CHD体外循环手术治疗且术后发生严重高胆红素血症（总胆红素[TB]≥85.5μmol/L）的所有患者。采用单因素和多因素分析确定研究终点的危险因素，包括术后急性肾损伤（AKI）、住院死亡率和长期死亡率。
筛选后，本研究纳入86例患者。住院死亡率为10.9%。51例（59.3%）患者发生AKI，4例（4.7%）患者接受持续肾脏替代治疗。多因素分析确定，TB峰值浓度（P = 0.002）和机械通气时间（P = 0.008）是住院死亡率的独立危险因素，3期AKI是长期死亡率的独立危险因素。TB峰值浓度的最佳截断值为125.9μmol/L。术后TB水平≥125.9μmol/L的患者长期生存率较差。
高胆红素血症是CHD手术后常见的并发症。术后严重高胆红素血症≥125.9μmol/L且发生AKI的CHD患者死亡风险更高。
