Jaundice in critical illness: promoting factors of a concealed reality

Brienza, Nicola; Dalfino, Lidia; Cinnella, Gilda; Diele, Caterina; Bruno, Francesco; Fiore, Tommaso

doi:10.1007/s00134-005-0023-3

Cited by 116 publications

(103 citation statements)

References 36 publications

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“…They argument that the cause of elevated bilirubin is directly related to the pathogenesis of appendicitis and the invasion of gram-negative bacteria into muscularis propria of the appendix, leading to direct invasion or translocation into the portal venous system and into the hepatic parenchyma interfering with the excretion of bilirubin into the bile canaliculi by a mechanism caused by the bacterial endotoxin [19]. Though this argument has sense, and hepatic dysfunction during bacterial sepsis by gram-negatives has been suffi ciently proved [21,24,37], the use of bilirubin levels to support the diagnosis of perforated appendicitis does not seem to make sense because, as we have demonstrated, other serologic tests (CRP), and clinical variables (SIRS, time period of symptoms evolution) performed better than TB in the ROC curve analysis, and have a better sensitivity to predict perforation in patients with appendicitis.…”

Section: Total Bilirubin and Hyperbilirubinaemiamentioning

confidence: 99%

“…The rationale for this proposal is based on the hepatic dysfunction occurring during bacterial sepsis secondary to Gram negative bacteria [21], such as Escherichia coli, which is the main bacteria present in patients with appendicitis [22,23]. Consequently a low-grade hyperbilirubinaemia, often unnoticed in septic patients not presenting clinically evident jaundice, is present in patients with gram-negative infections [24]. Our purpose with this study was to compare the performance of TB versus other well known unspecifi c infl ammatory markers (WBC and CRP), the time period of symptoms' evolution from the onset of symptoms to surgery, and the systemic infl ammatory response syndrome (SIRS), to suspect perforated appendicitis.…”

Section: Introductionmentioning

confidence: 99%

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Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Beltrán¹,

Méndez²,

Barrera³

et al. 2009

Indian J Surg

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Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic infl ammatory response syndrome (SIRS).Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specifi city of the tested variables. ResultsThe period of symptom's evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

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Section: Total Bilirubin and Hyperbilirubinaemiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Beltrán¹,

Méndez²,

Barrera³

et al. 2009

Indian J Surg

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“…High positive end-expiratory pressure is known to be an independent risk factor for liver dysfunction, as indicated by hyperbilirubinemia [6].…”

Section: Markus Kredel and Christian Wundermentioning

confidence: 99%

Myocardial injury associated with hyperinflation of the lung

Eisenhut

2007

Crit Care

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A recent study [1], conducted in an animal model of acute lung injury, compared a ventilation strategy in which lungs were inflated by brief application of 50 cmH 2 O pressure followed by increased positive end-expiratory pressure (recruitment strategy) versus conventional ventilation. The study identified an increased inflammatory reaction in liver sinusoids, and increased serum aspartate aminotransferase (AST) and hyaluronate levels with the recruitment strategy. The authors speculated that deficient oxygen delivery and increased sinusoidal pressures may have caused liver injury. The findings of the study suggest an origin of AST outside the liver because there was no elevation in alanine aminotransferase levels, hepatocellular necrosis, or liver dysfunction. Animals in the group receiving the recruitment strategy required volume support and had temporarily reduced cardiac output. This indicated that the origin of AST elevation was a myocardial injury.Previous studies found that patients with acutely elevated intrapulmonary pressure resulting from bronchospasm [2] and severe respiratory syncytial viral lung disease leading to hyperinflation [3] exhibited evidence of myocardial injury, such as elevated cardiac troponin levels; this was probably due to strain imposed on the right ventricle by pulmonary hypertension. Ventricular strain has previously also been associated with elevated hyaluronate levels [4]. The increase in hepatic neutrophils may be due to a hyperoxia-induced increased inflammatory response found in patients with increased positive end-expiratory pressure and fractional inspired oxygen (FiO 2 ) [5]. Future studies need to use specific markers for myocardial injury such as cardiac troponin T in order to discriminate between myocardial and hepatic injury associated with the various ventilation strategies. Letter Myocardial injury associated with hyperinflation of the lung Authors' response Markus Kredel and Christian WunderWe thank Dr Eisenhut for his comments. He raises the issue of whether myocardial injury was the origin of the increased serum AST levels observed in animals treated with the recruitment manoeuvre (RM). Although we did not measure troponin T levels, there was no evidence for myocardial injury during the performed RM. Haemodynamic variables, as shown in Table 1 of our report [1], and mixed venous oxygen saturation (data not shown) were comparable in the two groups at all time points. In addition, the expected and observed increase in central venous pressure and decrease in cardiac output during the RM did not result in differences in pulmonary artery pressure. This casts right ventricular strain into doubt.In addition to nonspecific transaminases and hyaluronic acid, bilirubin was also elevated in the systemic circulation in the group undergoing the RM. High positive end-expiratory pressure is known to be an independent risk factor for liver dysfunction, as indicated by hyperbilirubinemia [6].Regarding the histologic examination, Dr Eisenhut speculates that the increase in liver ...

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“…12 Study by Brienza et al showed that severe shock states, sepsis, mechanical ventilation with PEEP and major surgery were the critical risk factors for liver dysfunction. 13 Most of the studies have analysed individual components of LFT to assess the prognosis in critically ill patients. 14 Serum albumin was the most commonly used predictor in similar studies.…”

mentioning

confidence: 99%

Liver function tests as a prognostic indicator in Pediatric Intensive Care Unit (PICU)

Mallikarjuna

Sood

2018

Int J Contemp Pediatr

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Background: Frank liver failure is incompatible with life. Severity of liver disease is reflected in clinical signs or biochemical alterations. Hepatic dysfunction indicates poor outcome in critically ill patients, but no large systematic investigation into its exact incidence and prognostic relevance has been performed in different population groups.Methods: All PICU admissions during the study period were included. Pattern of admission LFT (Liver Function Tests) was reported. Relationship between clinical events and patient outcome with the LFT panel on day 1 and day 3 were reported. Association between final outcome and day 7 LFT was explored.Results: Deranged AST (Aspartate Transaminase), ALT (Alanine Transaminase), Bilirubin, Albumin, PT (Prothrombin time) and INR (International Normalized Ratio) on Day1 and 3 had significant association with increased requirement of inotropic and ventilatory support as well with increased mortality. LFT parameters on day 7 showed significant correlation between normal AST, ALT, bilirubin, PT and INR with improved survival.Conclusions: LFT's should be essential part of biochemical profile and doctors caring for sick patients in peripheral hospitals should consider for early referral of patients to higher centers based on LFT parameters for the advanced care they deserve.

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Jaundice in critical illness: promoting factors of a concealed reality

Cited by 116 publications

References 36 publications

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Myocardial injury associated with hyperinflation of the lung

Liver function tests as a prognostic indicator in Pediatric Intensive Care Unit (PICU)

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