Department of Anesthesiology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Sci Rep. 2024 Sep 18;14(1):21762. doi: 10.1038/s41598-024-72676-6.
Bilirubin is one of the most frequently used laboratory values to monitor critically ill patients with cholestatic liver dysfunction. Besides bilirubin, toxic bile acids (TBAs), which may cause severe organ damage, are typically elevated. A correlation between both parameters seems plausible, but data are lacking. The aim was to investigate whether there is a correlation between bilirubin and TBAs in patients' blood and whether a compareable reduction can be observed during the use of the adsorber CytoSorb (CS). As part of the Cyto-SOLVE study (NCT04913298), 16 critically ill patients with cholestatic liver dysfunction, bilirubin concentration > 10 mg/dl, continuous kidney replacement therapy and CS-application were investigated. Bilirubin and TBA concentrations were measured from arterial blood at defined time points (before start, after 6 and 12 h). Relative reduction (RR) was calculated using the formula[Formula: see text]. A moderate to high correlation between bilirubin and TBA concentration at all defined timepoints (r=0.64, p = 0.008; r = 0.85, p < 0.001, r = 0.72, p = 0.002) was observed. In the first six hours of CS-application, a significant elimination of TBA (median TBA: 30.8→20.1µmol/l, p < 0.001) and bilirubin (median bilirubin: 17.1→11.9 mg/dl, p < 0.001) was observed. The median RR after 6 h was 26.1% and 39.8% for bilirubin and TBA, respectively. No further reduction was observed after 12 h (RR: - 0.6%, RR: 1.8%). There was an at least moderate correlation between bilirubin and TBA in patients with cholestatic liver dysfunction. Therefore, bilirubin seems to be a suitable surrogate parameter for TBA elimination during CytoSorb application.
胆红素是监测胆汁淤积性肝功能障碍危重症患者的最常用实验室指标之一。除胆红素外，毒性胆汁酸（TBA）通常也会升高，其可能导致严重的器官损伤。这两个参数之间似乎存在相关性，但目前缺乏相关数据。本研究旨在探讨患者血液中胆红素与 TBA 之间是否存在相关性，以及在使用吸附剂 CytoSorb（CS）时是否可以观察到类似的降低。作为 Cyto-SOLVE 研究（NCT04913298）的一部分，研究了 16 例胆汁淤积性肝功能障碍、胆红素浓度>10mg/dl、持续肾脏替代治疗和 CS 应用的危重症患者。在定义的时间点（开始前、6 小时和 12 小时后）从动脉血中测量胆红素和 TBA 浓度。使用公式[公式：见正文]计算相对减少率（RR）。在所有定义的时间点，胆红素和 TBA 浓度之间存在中度至高度相关性（r=0.64，p=0.008；r=0.85，p<0.001，r=0.72，p=0.002）。在 CS 应用的前 6 小时内，TBA（中位数 TBA：30.8→20.1µmol/l，p<0.001）和胆红素（中位数胆红素：17.1→11.9mg/dl，p<0.001）的消除显著。6 小时后 RR 的中位数分别为 26.1%和 39.8%。12 小时后无进一步降低（RR：-0.6%，RR：1.8%）。在胆汁淤积性肝功能障碍患者中，胆红素与 TBA 之间存在至少中度相关性。因此，在 CS 应用期间，胆红素似乎是 TBA 消除的合适替代参数。
