The incidence, risk factors, and prognosis of postoperative hyperbilirubinemia after cardiac surgery: a systematic review and meta-analysis

Abstract

Background: The purpose of the present systematic review was to evaluate the incidence, risk factors, and outcome of hyperbilirubinemia after cardiac surgery.Methods: The Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework was employed to develop the search strategy, and the findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Embase, and the Cochrane Library were systematically searched for studies that provided data on the incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac surgery patients from January 1960 to May 2020. Publication bias was graphically explored through funnel plots, and the Newcastle-Ottawa quality assessment scale (NOS) was used to evaluate the quality of the included studies.Results: Ten studies with 6,100 patients were included in our systematic review. The pooled incidence of hyperbilirubinemia was 23% [95% confidence interval (CI), 0.13-0.32]. Preoperative factors, including right atrial pressure [mean difference (MD), 4.65; 95% CI, 4.43-4.88], total bilirubin (TB) concentration (MD, 0.72; 95% CI, 0.65-0.79), alkaline phosphatase (MD, 27.38; 95% CI, 12.94-41.82), and alanine aminotransferase (MD, 12.02; 95% CI, 10.73-13.31), and intraoperative factors, including cardiopulmonary bypass (CPB) time (MD, 1.57; 95% CI, 0.52-2.63), aortic cross-clamping (ACC) time (MD, 11.82; 95% CI,, and the amount of blood transfused (MD, 3.77; 95% CI, 0.68-6.85), were the most robust risk factors for hyperbilirubinemia after cardiac surgery. Additionally, postoperative hyperbilirubinemia was associated with increased in-hospital mortality [odds ratio (OR), 9.9; 95% CI, 5.00-19.60, P<0.0001].Discussion: Hyperbilirubinemia was common and was associated with increased in-hospital mortality.Preoperative high right atrial pressure, high TB concentration, prolonged CPB and ACC time, and a large amount of blood transfused were the commonly observed risk factors for postoperative hyperbilirubinemia in cardiac surgery patients. Addressing these risk factors may be helpful to lower the occurrence of postoperative hyperbilirubinemia.

Risk factors of renal replacement therapy after heart transplantation: a retrospective single-center study

“…The establishment of the CPB circuit will also increase the production of reactive oxygen species and inflammatory factors and induce acute tubular necrosis. In addition, hyperbilirubinemia after cardiac surgery with CPB is frequently observed and associated with worse outcomes (27). A large prospective study found a positive association between hyperbilirubinemia and the incidence of AKI after CPB (28).…”

“…Our study reveals that a postoperative TBIL ≥60 umol/L is an independent risk factor for requiring RRT after HT (OR =5.105; 95% CI: 1.868-13.952; P=0.001). Though the exact cause of this liver dysfunction is unknown, it may be secondary to liver hypoperfusion, hemolysis or a systemic inflammatory response to CPB (27).…”

Hyperbilirubinemia after surgical repair for acute type a aortic dissection: A propensity score-matched analysis

“…Hyperbilirubinemia is a common complication that occurs after cardiac surgery due to hemolysis and/or liver hypoperfusion, especially under cardiopulmonary bypass (CPB) ( Collins et al, 1983 ; Wang et al, 1994 ). Previous studies indicated that the incidence of postoperative hyperbilirubinemia (PH) ranged from 10% to 40% in cardiac surgery and associated with increased postoperative morbidity and mortality ( Nishi et al, 2012 ; Yang et al, 2019 ; Chen et al, 2021 ). However, the clinical significance of PH after surgical repair of ATAAD has not been evaluated.…”

Jaundice and Its Results After Cardiac Surgery

“…Jaundice due to hyperbilirubinemia develops in 10-23% of patients in the early period after cardiac surgery. [1,2] Despite advances in surgical techniques and post-operative patient care, the incidence of hyperbilirubinemia does not appear to have decreased compared to studies 40 years ago. [3] Increasing and severe hyperbilirubinemia occurring in the late post-operative days was associated with higher mortality and morbidity than mild hyperbilirubinemia occurring in the 1 st days.…”