Peng Milin, Deng Fuxing, Qi Desheng, Hu Zhonghua, Zhang Lina
Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Front Med (Lausanne). 2021 Sep 17;8:713917. doi: 10.3389/fmed.2021.713917. eCollection 2021.
Although hyperbilirubinemia has been associated with mortality in patients who are critically ill, yet no clinical studies dissect the effect of dynamic change of hyperbilirubinemia on long-term septic prognosis. The study aims to investigate the specific stages of hyperbilirubinemia and potential risk factors on long-term outcomes in patients with sepsis. In this retrospective observational cohort study, patients with sepsis, without previous chronic liver diseases, were identified from the Medical Information Mart for the Intensive Care III MIMIC-III database. We used propensity scores (PS) to adjust the baseline differences in septic patients with hyperbilirubinemia or not. The multivariate Cox was employed to investigate the predictors that influence a clinical outcome in sepsis. Of 2,784 patients with sepsis, hyperbilirubinemia occurred in 544 patients (19.5%). After PS matching, a survival curve demonstrated that patients with sepsis with the new onset of total bilirubin (TBIL) levels more than or equal to 5 mg/dl survived at significantly lower rates than those with TBIL levels <5 mg/dl. Multivariate Cox hazard analysis showed that patients with TBIL at more than or equal to 5 mg/dl during sepsis exhibit 1.608 times (95% CI: 1.228-2.106) higher risk of 1-year mortality than those with TBIL levels <5 mg/dl. Also, age above 65 years old, preexisting malignancy, a respiratory rate above 30 beats/min at admission, serum parameters levels within 24-h admission, containing international normalized ratio (INR) above 1.5, platelet <50109/L, lactate above 4 mmol/L, and bicarbonate <22 or above 29 mmol/L are the independent risk factors for long-term mortality of patients with sepsis. After PS matching, serum TBIL levels at more than or equal to 5 mg/dl during hospitality are associated with increased long-term mortality for patients with sepsis. This study may provide clinicians with some cutoff values for early intervention, which may improve the prognosis of patients with sepsis.
尽管高胆红素血症与危重症患者的死亡率相关，但尚无临床研究剖析高胆红素血症动态变化对长期脓毒症预后的影响。本研究旨在探讨高胆红素血症的特定阶段以及脓毒症患者长期预后的潜在危险因素。在这项回顾性观察队列研究中，从重症监护医学信息集市三期（MIMIC-III）数据库中识别出无既往慢性肝病的脓毒症患者。我们使用倾向评分（PS）来调整有或无高胆红素血症的脓毒症患者的基线差异。采用多变量Cox模型来研究影响脓毒症临床结局的预测因素。在2784例脓毒症患者中，544例（19.5%）出现高胆红素血症。PS匹配后，生存曲线显示，总胆红素（TBIL）水平新出现≥5mg/dl的脓毒症患者生存率显著低于TBIL水平<5mg/dl的患者。多变量Cox风险分析显示，脓毒症期间TBIL≥5mg/dl的患者1年死亡率风险比TBIL水平<5mg/dl的患者高1.608倍（95%CI：1.228 - 2.106）。此外，年龄≥65岁、既往有恶性肿瘤、入院时呼吸频率>30次/分钟、入院24小时内的血清参数水平，包括国际标准化比值（INR）>1.5、血小板<50×10⁹/L、乳酸>4mmol/L以及碳酸氢盐<22或>29mmol/L是脓毒症患者长期死亡的独立危险因素。PS匹配后，住院期间血清TBIL水平≥5mg/dl与脓毒症患者长期死亡率增加相关。本研究可能为临床医生提供一些早期干预的临界值，这可能改善脓毒症患者的预后。
