Hyperbilirubinemia after Cardiopulmonary Bypass: A Prospective Study

Chandra, Abha; Gupta, D; Saibaba, K. S. S.; Dilip, Dronamraju; Kola, Srinivas; Naidu, Madhu Sudan

doi:10.1177/021849239900700102

Cited by 4 publications

(8 citation statements)

References 6 publications

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“…13–15 Chandra and colleagues reported an overall incidence of hepatic dysfunction to be as high as 26%, but, on excluding patients with preoperative hyperbilirubinemia, the actual incidence was found to be 19%. 16 Similarly, in a patient group undergoing cardiac surgery with normal preoperative liver function tests, Mastoraki et al reported postoperative hyperbilirubinemia to be 26.5%. 17…”

Section: Discussionmentioning

confidence: 95%

Evaluation of different types of inferior vena cava cannulae placement by transesophageal echocardiography and its impact on hepatic dysfunction

et al. 2016

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Section: Discussionmentioning

confidence: 95%

Evaluation of different types of inferior vena cava cannulae placement by transesophageal echocardiography and its impact on hepatic dysfunction

et al. 2016

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“…These underwent full-text review. Finally, 10 studies with 6,100 subjects were included in the present systematic review (3,(7)(8)(9)(10)(12)(13)(14)(15)18). The characteristics of the included studies are summarized in Table 1.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…All of the included studies were observational in design. Seven (70%) of the included studies enrolled prospective cohorts (3,(8)(9)(10)(13)(14)(15)18). Of these included studies, the criterion for hyperbilirubinemia diagnosis was lower than 3 mg/dL in 4 studies and higher than 3 mg/dL in 6 studies.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Some reports indicated that hyperbilirubinemia after cardiac surgery was associated with poor prognosis, including prolonged hospital stay and ICU stay and increased in-hospital mortality (3,7,8,(10)(11)(12). However, other studies showed no association between the development of postoperative hyperbilirubinemia and mortality (13,14). The impact of postoperative hyperbilirubinemia on in-hospital mortality remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…It has been previously proved that the use of CPB is related to early hyperbilirubinemia and transient liver dysfunction [ 14 , 18 ]. Nonetheless, the mortality rates of patients with severe hyperbilirubinemia were heterogeneous in previous reports.…”

Section: Discussionmentioning

confidence: 99%

Time to peak bilirubin concentration and advanced AKI were associated with increased mortality in rheumatic heart valve replacement surgery patients with severe postoperative hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2021

BMC Cardiovasc Disord

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Background Hyperbilirubinemia after heart valve surgery (HVS) with cardiopulmonary bypass is frequently observed and associated with worse outcomes. We investigated the characteristics and prognosis of patients with severe hyperbilirubinemia after HVS for rheumatic heart disease (RHD) to identify the clinical outcomes and potential risk factors. Methods Between 2015 and 2018, patients who underwent HVS in the cardiac surgery intensive care unit of our hospital were retrospectively screened. Risk factors for acute kidney injury (AKI), the requirement for continuous renal replacement therapy (CRRT), and in-hospital and long-term mortality were identified by univariate and multivariate analyses. The patient survival proportion was graphically presented with the Kaplan–Meier method. Results A total of 149 patients who underwent HVS for RHD and had severe postoperative hyperbilirubinemia were included. Of the included patients, 80.5% developed postoperative AKI, and 18.1% required CRRT. The in-hospital mortality was 30.2%. Backward logistic regression analysis showed that the time to peak TB concentration (odds ratio [OR] 1.557, 95% confidence interval [CI] 1.259–1.926; P < 0.001) and advanced AKI (stage 2 and 3 AKI) (OR 19.408, 95% CI 6.553–57.482; P < 0.001) were independent predictors for in-hospital mortality. The cutoff value of the time to peak TB levels for predicting in-hospital mortality was 5 postoperative days. Conclusions Severe postoperative hyperbilirubinemia is a life-threatening complication in patients who undergo HVS for RHD. Patients whose bilirubin levels continued to increase past the 5th postoperative day and who had advanced AKI (stages 2 and 3) were associated with a higher risk of mortality.

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Hyperbilirubinemia after Cardiopulmonary Bypass: A Prospective Study

Cited by 4 publications

References 6 publications

Evaluation of different types of inferior vena cava cannulae placement by transesophageal echocardiography and its impact on hepatic dysfunction

Evaluation of different types of inferior vena cava cannulae placement by transesophageal echocardiography and its impact on hepatic dysfunction

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

Time to peak bilirubin concentration and advanced AKI were associated with increased mortality in rheumatic heart valve replacement surgery patients with severe postoperative hyperbilirubinemia: a retrospective cohort study

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