Hyperbilirubinemia as a Risk Factor for Mortality and Morbidity in Trauma Patients

Abstract

Hyperbilirubinemia is frequently reported in trauma patients. However, few studies have investigated the effects of hyperbilirubinemia on patients’ clinical trajectories. This study aimed to evaluate the relationship between hyperbilirubinemia and patient outcomes following trauma. Our study included 387 patients who were admitted to the trauma bay with severe trauma between January 2017 and December 2021. We categorized patients into two groups based on their peak bilirubin levels: the low-bilirubin (LB) group, with levels below 3 mg/dL, and the high-bilirubin (HB) group, with levels above 3 mg/dL. We then compared the rates of complications and mortality between these two groups. The incidence of pneumonia (10.8% vs. 32.3%, p < 0.001), acute kidney injury (AKI) (2.8% vs. 19.2%, p < 0.001), sepsis (2.8% vs. 10.1%, p = 0.003), and wound infections (8.3% vs. 30.3%, p < 0.001) was significantly higher in the HB group. Additionally, the mortality rate was significantly higher (4.2% vs. 10.1%, p = 0.028) in the HB group. Multivariate analysis revealed that the higher the bilirubin level, the greater the risk of complications (pneumonia: odds ratio [OR] = 3.238; 95% confidence interval [CI] = 1.68–6.22; p < 0.001, AKI: OR = 4.718; 95% CI = 1.65–13.44; p = 0.004, sepsis: OR = 3.087; 95% CI = 1.00–9.52; p = 0.04, wound infection: OR = 3.995; 95% CI = 2.073–7.700; p < 0.001). In conclusion, hyperbilirubinemia was associated with poorer outcomes in trauma patients.

Evaluation of the Easy Albumin–Bilirubin Score as a Prognostic Tool for Mortality in Adult Trauma Patients in the Intensive Care Unit: A Retrospective Study

“…The ALBI score combines two essential markers of the liver's metabolic (bilirubin) and synthetic (albumin) activities [43]. Patients who have suffered trauma, particularly from accidents, falls, or acts of violence, may experience a heightened loss of red blood cells, thereby resulting in increased bilirubin levels [44]. Hyperbilirubinemia in critically ill patients can be attributed to various factors, such as biliary obstruction, liver disease, hemolysis, hematoma resorption, and medication toxicity [44][45][46].…”

“…Patients who have suffered trauma, particularly from accidents, falls, or acts of violence, may experience a heightened loss of red blood cells, thereby resulting in increased bilirubin levels [44]. Hyperbilirubinemia in critically ill patients can be attributed to various factors, such as biliary obstruction, liver disease, hemolysis, hematoma resorption, and medication toxicity [44][45][46]. The liver is responsible for the primary processing and elimination of bilirubin.…”

“…Elevated bilirubin levels are indicative of liver malfunction, which has the potential to exacerbate a patient's overall disease status [45,46]. Elevated levels of bilirubin may serve as an indicator of tissue damage and the degree of injury [44]. Nevertheless, trauma patients may develop hyperbilirubinemia even in the absence of a pre-existing hepatobiliary illness.…”