Severe postoperative hyperbilirubinemia in congenital heart disease

Abstract

Purpose The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia. Methods All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality. Results After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration (P = 0.002) and duration of mechanical ventilation (P = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival. Conclusion Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.

Association between congenital heart disease and parenteral nutrition–associated liver disease in neonates: A retrospective cohort study

“…As duration of PN administration and PNALD are directly related, we introduced a culminate time-varying covariate for days of PN exposure, starting from the beginning of the observation through the 28day period after the final PN administration to account for potentially differing odds of PNALD on days without PN administration. Additionally, recent works have identified hyperbilirubinemia in postoperative patients with CHD, outside of any PN exposure 27. To account for potential bias from such interventions, a second time-varying covariate was added as a binary flag: a value of 0 for preoperative days and 1 for all days after the surgical intervention of an infant if relevant.The model was adjusted for demographics and first DOL receiving PN.…”