Xu Jiao, Jin Jun, Zhou Qing-Shan, Deng Jiang-Tao
Department of Anesthesiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China.
Department of Critical Care Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
Medicine (Baltimore). 2025 Jun 27;104(26):e43051. doi: 10.1097/MD.0000000000043051.
The liver plays a key role in the pathogenesis and resolution of acute respiratory distress syndrome (ARDS). Clinically, elevated serum bilirubin - especially direct bilirubin (DBIL) - is frequently observed in ARDS. This study aimed to evaluate the association between DBIL levels and 90-day mortality in ARDS patients. This retrospective cohort study used data from the MIMIC-IV database. ARDS patients were identified based on the Berlin definition. The primary outcome was 90-day all-cause mortality; in-hospital mortality was secondary. Cox proportional hazards models assessed the association between DBIL levels and mortality. Restricted cubic spline regression examined nonlinear relationships. Kaplan-Meier analysis compared survival across DBIL strata. A total of 714 ARDS patients were included. Patients with DBIL > 1.05 mg/dL had worse clinical profiles, including lower arterial pH, higher lactate, elevated ALT, and higher sequential organ failure assessment scores. Kaplan-Meier analysis showed significantly lower survival in the high DBIL group (52.2% vs 73.7%; P < .001). Multivariable Cox analysis showed elevated DBIL was independently associated with 90-day mortality (HR = 1.76; 95% CI = 1.33-2.33; P < .001) and in-hospital mortality (HR =1.99; 95% CI = 1.59-2.50; P < .001). Indirect bilirubin was not significantly associated with 90-day mortality. Restricted cubic spline analysis revealed a nonlinear relationship between DBIL and 90-day mortality (P for nonlinearity = .002). Our study demonstrates that DBIL is independently associated with 90-day mortality in patients with ARDS. Clinicians should consider close monitoring of DBIL levels and adjust management strategies accordingly to improve patient outcomes.
肝脏在急性呼吸窘迫综合征（ARDS）的发病机制及病情缓解过程中起着关键作用。临床上，ARDS患者常出现血清胆红素升高，尤其是直接胆红素（DBIL）升高。本研究旨在评估ARDS患者DBIL水平与90天死亡率之间的关联。这项回顾性队列研究使用了MIMIC-IV数据库中的数据。根据柏林定义确定ARDS患者。主要结局是90天全因死亡率；院内死亡率为次要结局。Cox比例风险模型评估DBIL水平与死亡率之间的关联。受限立方样条回归分析非线性关系。Kaplan-Meier分析比较不同DBIL分层的生存率。共纳入714例ARDS患者。DBIL>1.05mg/dL的患者临床特征更差，包括动脉血pH值更低、乳酸水平更高、谷丙转氨酶升高以及序贯器官衰竭评估评分更高。Kaplan-Meier分析显示，高DBIL组的生存率显著更低（52.2%对73.7%；P<.001）。多变量Cox分析显示，DBIL升高与90天死亡率独立相关（风险比[HR]=1.76；95%置信区间[CI]=1.33-2.33；P<.001）以及院内死亡率（HR=1.99；95%CI=1.59-2.50；P<.001）。间接胆红素与90天死亡率无显著关联。受限立方样条分析显示DBIL与90天死亡率之间存在非线性关系（非线性P值=.002）。我们的研究表明，DBIL与ARDS患者的90天死亡率独立相关。临床医生应考虑密切监测DBIL水平，并相应调整管理策略以改善患者预后。
