Hyperbilirubinemia; Current Causes, Causal Risk Factors and Endpoints

Abstract

Objectives: Hyperbilirubinemia has a broad spectrum of causes ranging from benign lifethreatening. Classification of hyperbilirubinemia as prehepatic, hepatic and posthepatic promotes detecting its etiology. Materials and Methods: In this study, we analyzed the diagnoses, etiological risk factors and endpoints in 60 patients with hyperbilirubinemia. Inclusion criteria included moderate-bad general condition, enzyme levels >2000 U/L, bilirubin levels >5 mg/dL, impaired coagulation parameters and fever and rashes. Age, gender, etiology, contamination patterns, physical examination, laboratory findings and prognosis were analyzed retrospectively. Results: The diagnoses of the diseases based on their incidence were hepatitis B (n=34), hepatitis A (n=12), activation of chronic HBV infection (n=5), autoimmune hepatitis (n=2), malaria (n=2), hepatitis E (n=1), leptospirosis (n=1) and liver abscess (n=1). Mean age and female/male distribution ratio for viral hepatitis were 33 and 1/2, respectively. When risk factors were questioned; risk factors could not be identified in 69% of patients with viral hepatitis. Use of municipal water was found in history of 17% cases with hepatitis A whereas history of suspected sexual contact and dental treatment were found in 26% and 17% of patients with hepatitis B. Intrafamilial contamination was found in seven cases. Bicytopenia and monocytosis were observed in 15% and 84% of subjects. The mean bilirubin value was 16 mg/ dL with the highest value of 44.6 mg/dL. The highest ALT were averagely 3170 U/L and 2891 U/L in patients with hepatitis A and B, respectively. Two patients became exitus while one patient was referred to an external center for transplantation. The diagnoses in those three patients were hepatitis B and autoimmune hepatitis. Conclusion: Although, joundice is related with many diseases, in Turkey, it is most commonly associated with viral hepatitis.