Severe hyperbilirubinemia is associated with higher risk of contrast-related acute kidney injury following contrast-enhanced computed tomography

Abstract

Introduction Contrast-induced acute kidney injury (CI-AKI) is associated with high risks of morbidity and mortality. Hyperbilirubinemia might have some renal protection but with no clear cutoff value for protection. Related studies are typically on limited numbers of patients and only in conditions of vascular intervention. Methods We performed this study to elucidate CI-AKI in patients after contrast-enhanced computed tomography (CCT). The outcomes were CI-AKI, dialysis and mortality. Patients were divided to three groups based on their serum levels of total bilirubin: �1.2 mg/dl, 1.3-2.0 mg/dl, and >2.0 mg/dl. Results We enrolled a total of 9,496 patients who had received CCT. Patients with serum total bilirubin >2.0 mg/dl were associated with CI-AKI. Those undergoing dialysis had the highest incidence of PC-AKI (p<0.001). No difference was found between the two groups of total bilirubin �1.2 and 1.3-2.0 mg/dl. Patients with total bilirubin >2mg/dl were associated with CI-AKI (OR = 1.89, 1.53-2.33 of 95% CI), dialysis (OR = 1.40, 1.01-1.95 of 95% CI) and mortality (OR = 1.63, 1.38-1.93 of 95% CI) after adjusting for laboratory data and all comorbidities (i.e., cerebrovascular disease, coronary artery disease, peripheral arterial disease, and acute myocardial infarction, diabetes mellitus, hypertension, gastrointestinal bleeding, cirrhosis, peritonitis, ascites, hepatoma, shock lung and colon cancer). We concluded that total bilirubin level >2 mg/dl is an independent risk factor for CI-AKI, dialysis and mortality after CCT. These patients also had high risks for cirrhosis or hepatoma.

Low Albumin, Low Bilirubin, and High Alfa-Fetoprotein Are Associated with a Rapid Renal Function Decline in a Large Population Follow-Up Study

“…A prospective observational study reported an association between low bilirubin concentration and the composite of a two-fold increase in serum creatinine or ESRD requiring dialysis in Japanese patients with stages 3–5 CKD [ 12 ]. Nevertheless, some studies have reported opposite findings [ 13 , 34 , 35 ]. Majoni et al reported that a high bilirubin concentration was associated with a faster annual decline in eGFR but better renal outcomes in an Australian population [ 13 ].…”

“…A cross-sectional study conducted in the United States also demonstrated associations between a high bilirubin concentration and low eGFR and increased albuminuria in healthy adults [ 34 ]. In addition, a large retrospective study reported that hyperbilirubinemia (total bilirubin > 2.0 mg/dL) was an independent risk factor for contrast-induced acute kidney injury, dialysis, and mortality after receiving contrast-enhanced computed tomography [ 35 ].…”

Serum Total Bilirubin Level Is Associated With Hospital Mortality Rate in Adult Critically Ill Patients: A Retrospective Study

“…Diagnosis of liver diseases and hemolytic anemia was carried out according to 9th revision of the International Classification of Diseases code. Based on previous studies on bilirubin ( 15 , 16 ), Patients were stratified into two cohorts according to maximum concentrations of total bilirubin 24 h after admission as follows: (1) serum total bilirubin level < 2 mg/dL, (2) serum total bilirubin level ≥ 2 mg/dL. The primary outcome in the present investigation was in-hospital mortality.…”

North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension

“…Kidney function should be assessed before TIPS either through measurement of sCr or GFR (estimated or measured). 75,[158][159][160][161][162] A change in GFR may best capture changes in kidney function. The limitations of sCr in cirrhosis have been well documented (Supplementary Discussion section).…”