Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury

Cui, Yun; Shan, Yijun; Chen, Rongxin; Wang, Chunxia; Zhang, Yucai

doi:10.1155/2018/4591729

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Liver injury is a common risk factor for poor mortality in patients with sepsis. 20 The incidence rate of sepsis-associated ALI in patients enrolled in this study during a 1-year period was 12.2% (10/82), which is consistent with our previous retrospective study on the sepsis-associated ALI incidence rate (9.7%, 72/745) 21 ; however, the incidence rate observed in the current study was lower than that of a recent study conducted in Southwest China (19.6%). 3 The PICU mortality of patients with sepsis-associated ALI was 40% in the present study, which is consistent with the observation of our previous retrospective study (36.1 [26/72]).…”

Section: Discussionsupporting

confidence: 90%

“…3 The PICU mortality of patients with sepsis-associated ALI was 40% in the present study, which is consistent with the observation of our previous retrospective study (36.1 [26/72]). 21 The mortality rate was significantly higher in patients with sepsis-associated ALI (40%, 4/10) than in patients without ALI (12.5%, 9/72) in our present study. Therefore, early identification of liver injury during sepsis needs more clinical and research attention and will be helpful for developing strategies for improving the outcome of sepsis.…”

Section: Discussioncontrasting

confidence: 41%

“…Our previous study indicated that a TBIL value >64.5 μmol/L within 72 hours after PICU admission is an independent risk factor for mortality in patients with sepsis-associated ALI. 21 In the present study, the level of TBIL on PICU admission was 11.995 μmol/L (95% CI: 8.34-77.95) in patients with sepsis-associated ALI, and it was not associated with prognosis of pediatric sepsis. These results suggested that serum VTN is an earlier prognostic predictor compared with TBIL.…”

Section: Discussionmentioning

confidence: 41%

See 2 more Smart Citations

Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

Wang

Cui

Miao

et al. 2020

Clin Appl Thromb Hemost

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Vitronectin (VTN) is a key regulator of coagulation, but clinical relevance of serum VTN in pediatric sepsis remains poorly defined. The aim of this study was to access the value of serum VTN level on pediatric intensive care unit (PICU) admission in children with sepsis. Pediatric patients with sepsis were enrolled from January 2018 to December 2018. The serum VTN levels were determined on PICU admission, and the association of serum VTN level with PICU mortality and organ dysfunction was assessed. Serum VTN levels were significantly lower in nonsurvivors compared with survivors, in patients with septic shock compared with patients with sepsis, or in patients with sepsis-associated acute liver injury (ALI) compared with patients without ALI. Serum VTN level was associated with PICU mortality (odds ratio [OR]: 0.958, 95% CI: 0.927-0.996; P = .010) or ALI (OR: 0.956, 95% CI: 0.915-0.999; P = .046), but not shock (OR: 0.996, 95% CI: 0.977-1.016; P =.716). The area under receiver operating characteristic curve for VTN in predicting the occurrence of ALI during PICU stay and PICU mortality were 0.760 (95% CI: 0.627- 0.893) and 0.737 (95% CI: 0.544-0.931), respectively. Moreover, VTN plus pediatric risk of mortality (PRISM) III had a better clinical utility according to decision curve analysis compared with VTN or PRISM III alone. These findings suggest that serum VTN level is associated with sepsis-associated ALI and PICU mortality, and VTN plus PRISM III is a powerful predictor of PICU mortality in pediatric patients with sepsis, which have a better clinical benefit compared with VTN or PRISM III alone.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 41%

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Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

Wang

Cui

Miao

et al. 2020

Clin Appl Thromb Hemost

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“…In addition, we also found that TBIL was signi cantly different in sepsis compared with infection or healthy controls, and showed certain diagnostic value. Given that hyperbilirubinemia is a common complication of sepsis, it is used as an indicator of liver function in APA CHEII and sequential organ failure scores (8), which is associated with poor prognosis of sepsis -associated liver injury (25). Some studies also believe that although TBIL is higher in the sepsis group, its correlation is not clinically signi cant because it is a parameter of the SOPA standard (26).…”

Section: Discussionmentioning

confidence: 99%

The Significance of Routine Biochemical Markers in Patients With Sepsis

Meng

Wang

Qiao

et al. 2020

Preprint

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Background: Sepsis is a highly complex and fatal syndrome. It is the main cause of death in the intensive care unit. Early diagnosis is beneficial to reduce the mortality of sepsis and improve the prognosis of patients. Therefore, we look forward to finding cheap and fast diagnostic criteria to quickly assess the patient's condition.Methods: This is a retrospective study. The study enrolled 499 patients in the First Affiliated Hospital of Xinjiang Medical University from January 1, 2018 to June 22, 2020, and 96 healthy cases in the same period. Using the diagnostic criteria of bacterial infection, SIRS criteria and Sepsis-2 consensus criteria, 499 patients and 96 healthy cases were divided into 4 groups: sepsis group (n=300), SIRS group (n=151), infection group (n= 48), the control group (n=96). We collected the results of routine laboratory tests, inflammation indicators and blood culture results of these patients. Results: The sepsis group compared with the control group, MCV, NE, WBC, PLT, HB, D-Dimer, PT, CRP, PCT, IL-6, ALB, TBIL, Cr, LAC, CysC and BNP were statistically significant. D-dimer, CRP and PCT have higher diagnostic efficiency. Compared with the difference between the infection group and the SIRS group, PLT and IL-6 are statistically significant, and have a certain diagnostic value. Sepsis group VS infection group, WBC, IL-6, NE and TBIL showed statistical differences in the comparison. The AUC of NE was 67.6, which was the largest among the three. The specificity (95.8%) was the highest, but the sensitivity (49%) was low.Conclusions: This retrospective study shows that NE, WBC, and D-dimer can help in the early diagnosis of sepsis. D-dimer performs best. WBC and NE may have a differential diagnosis significance between the sepsis group and the infection group. This result can provide a timely and convenient assessment tool for early diagnosis of sepsis.

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“…Gupta, T et al demonstrated that elevated hepatic SOFA scores were most predictive of in-hospital death [21] . In addition, serum T-BIL level lactate level, lactate clearance rate, increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and decreased C3 and C4 were all independent risk factors for the prognosis of liver injury [22][23][24][25] . However, there is still a lack of cohort studies with large samples, and there are few studies on the long-term prognosis of SALI [26] .…”

Section: Introductionmentioning

confidence: 99%

Total SOFA and SOFA Kidney are Associated with Short Term and Long term Outcoming of Sepsis-Associated Liver Injury

Liang²,

et al. 2021

Preprint

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Background: Liver injury is considered as a common complication of sepsis. However, there are still few studies on short-term and long-term prognostic factors of sepsis-associated liver injury (SALI). The objective of our study is to conduct a large sample data cohort study to explore the risk factors for short-term and long-term prognosis of SALI.Methods: Data from a public, US-based, critical-care database (Medical Information Mart for Intensive Care-III [MIMIC-III]) was used. Septic patients who met the definition of acute liver injury were enrolled. Variables extracted from MIMIC-III were used to evaluate patient demographics, clinical characteristics on Day 1 of intensive care unit admission, and clinical outcomes. The Logistic regression models were used to calculate risk ratio (RR) and 95% confidence intervals (CIs) after adjusting for potential factors. Results: Among the 14687 participants in our study, there were 3140 (21.38%) with SALI. SALI was significantly positively associated with ICU mortality (RR, 1.54; 95% CI, 1.32, 1.79), 28-day mortality (RR, 1.27; 95% CI, 1.11, 1.45) and 1-year mortality (RR, 1.19; 95% CI, 1.06, 1.34) after adjusting confounding factors. Stratified by SOFA, there was a positive association between SALI and ICU mortality (RR, 2.15; 95% CI, 1.64, 2.80), 28-day mortality (RR, 1.60; 95% CI, 1.28, 1.99), 1-year mortality (RR, 1.24; 95% CI, 1.04, 1.48) after adjusting confounding factors among people with sofa score ≤ 5. Similar results were also obtained between SALI and ICU mortality (RR,1.40; 95% CI, 1.17, 1.67), 28-day mortality (RR, 1.17; 95% CI, 0.99, 1.38), 1-year mortality (RR, 1.19; 95% CI, 1.02, 1.38) after adjusting confounding factors among people with sofa score> 5. Compared with SOFA renal> 1, SALI had a stronger positive correlation with ICU mortality (RR, 1.36; 95% CI, 1.01, 1.84), 28-day mortality (RR, 1.19; 95% CI, 0.91, 1.56), 1-year mortality (RR, 1.11; 95% CI, 0.88, 1.41) after adjusted confounding factors among people with SOFA renal ≤ 1.Conclusions: SALI was an independent risk factor for ICU mortality, 28-day mortality and 1-year mortality. And there is a close association between liver and kidney in sepsis, but the mechanism is still unclear and requires further study.

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Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury

Cited by 11 publications

References 22 publications

Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

The Significance of Routine Biochemical Markers in Patients With Sepsis

Total SOFA and SOFA Kidney are Associated with Short Term and Long term Outcoming of Sepsis-Associated Liver Injury

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