Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Abstract

bilirubin, and is associated with a high mortality. Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial pressure, numbers of valve replacement procedures, and the amount of blood transfusion requirement during and shortly after surgery. We suggest that postoperative hyperbilirubinemia is a multifactorial process, which is caused by both the impaired liver function of bilirubin transport and the increased production of bilirubin from haemolysis. INTRODUCTIONIt has long been recognized that early hyperbilirubinemia or transient jaundice could occur after extracorporeal circulation surg er y. According to earlier studies, overall incidence of postoperative hyperbilirubinemia ranges from about 8.6% to even as high as 40% [1][2][3] . Despite improvements in perioperative management, as well as in surgical and anaesthetic techniques, early hyperbilirubinemia after modern extracorporeal circulation surgery is still seen quite often. The high frequency of hyperbilirubinemia after cardiac surgery in our department prompted us to start a prospective study recently. It is aimed to clarify the incidence and nature of postoperative hyperbilir ubinemia in patients following moder n extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. Abstract AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern e x t r a c o r p o r e a l c i r c u l a t i o n , t o a n a l y z e p o s s i b l e perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. MATERIALS AND METHODS Patients' backgrounds METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters w e r e c o m p a r e d b y l o g i s t i c r e g r e s s i o n b e t w e e n hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality. R E S U LT S :O v e r a l l i n c i d e n c e o f p o s t o p e r a t i v e hyperbilirubinemia was 25.3% (98/386). In patients w i t h p o s t o p e r a t i v e h y p e r b i l i r u b i n e m i a , 5 6 . 2 % reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3% on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P < 0.01), longer duration of mechanical ventilation (P < 0.05) and longer ICU stay ti...

Hyperbilirubinemia Induces Pro-Apoptotic Effects and Aggravates Renal Ischemia Reperfusion Injury

“…Perioperative hyperbilirubinemia of cardiac surgery is characterized by increased UCB, especially in the first 48 h after surgery [22,23]. The main source of UCB is hemolysis by CPB or other mechanical circulatory assist devices [22,23].…”

“…However, many factors may cause RIRI after cardiac surgery in ICU [5]. The hyperbilirubinemia resulted from hemolysis caused by CPB and hepatic dysfunction during surgery, the UCB level was usually highest at the end of surgery [22], so the UCB level was high during the surgery. Hence, the RIRI may also occur after hyperbilirubinemia.…”

Hepatic and renal effects of cardiopulmonary bypass

“…The latter, which can be observed in a setting of normal LFTs, is an independent predictor of worse outcome after cardiac surgery accounting for 25% mortality [20,21]. The risk factors for hyperbilirubinaemia are the same as the ones for hepatic failure [22].…”

Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient

“…As many as 25% of patients will experience temporary hyperbilirubinemia, as defined by a total bilirubin >3 mg/dL, but less than 1% of these patients will experience significant hepatocellular dysfunction that will progress to chronic hepatitis or hepatic failure. 190,191 Although the mortality rate of hyperbilirubinemia is 4%, one literature review found the mean mortality of actual liver failure to be 56%. 178 Causes of perioperative liver dysfunction include preoperative heart failure and resulting liver congestion, hemolysis from either CPB, the use of operative field suction, or prosthetic valves, blood transfusion, hypoxia, or reperfusion injury.…”