Incidence, Risk Factors, and Outcomes of Hyperbilirubinemia in Adult Cardiac Patients Supported by Veno‐Arterial ECMO

Abstract

The aims of this study were to evaluate the incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac patients with veno-arterial (VA) ECMO. Data on 89 adult patients with cardiac diseases who received VA ECMO implantation in our hospital were retrospectively reviewed. All patients were divided into the following three groups: 24 in normal group (N, total bilirubin [TBIL] ≤3 mg/dL), 30 in high bilirubin group (HB, 6 mg/dL ≥ TBIL > 3 mg/dL), and 35 in severe high bilirubin group (SHB, TBIL > 6 mg/dL). lg(variables + 1) was performed for nonnormally distributed variables. The incidence of hyperbilirubinemia (>3 mg/dL) was 73%. In a multiple linear regression analysis, lg(peak TBIL + 1) was significantly associated with lg(peak AST + 1) (b-coefficient 0.188, P = 0.001), lg(peak pFHb + 1) (b-coefficient 0.201, P = 0.003), and basic TBIL (b-coefficient 0.006, P = 0.009). Repeated measurement analysis of variance revealed that the main effect for three groups in pFHb and lg(AST + 1) was significant at first 3 days during ECMO. The patients in SHB had low platelets during ECMO and low in-hospital survival rate. Hyperbilirubinemia remains common in patients with VA ECMO and is associated with low platelets and high in-hospital mortality. Hemolysis and liver dysfunction during ECMO and basic high bilirubin levels are risk factors of hyperbilirubinemia.

Hyperbilirubinemia Induces Pro-Apoptotic Effects and Aggravates Renal Ischemia Reperfusion Injury

“…Perioperative hyperbilirubinemia of cardiac surgery is characterized by increased UCB, especially in the first 48 h after surgery [22,23]. The main source of UCB is hemolysis by CPB or other mechanical circulatory assist devices [22,23].…”

Bilirubin Safeguards Cardiorenal and Metabolic Diseases: a Protective Role in Health

“…In this respect, some studies have identified serum bilirubin levels as a potential indicator of liver dysfunction following cardiac insults. For example, Lyu et al have demonstrated that very high levels of serum bilirubin (> 3 mg/dL) following veno-arterial extracorporeal membrane oxygenation (ECMO) was associated with low in-hospital survival rate [34]. Very high serum bilirubin has been associated with poorer prognosis in patients with heart failure (HF) and serum bilirubin concentration could be an independent predictor of mortality and may improve risk stratification [35].…”

Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock

“…However, in cases of risk factors, such as the insufficient flow in the outflow cannula leading to a rise in the negative pump head pressure, necessity of a high blood flow, or development of pump head thrombosis, severe hemolysis can occur and is reported in up to 5% of patients [ 54 ]. Lyu et al retrospectively observed, in a total of 84 VA-ECMO patients, that increased levels of plasma free Hb are associated with acute renal failure [ 55 ]. Omar et al even identified severe hemolysis (peak plasma free Hb > 500 mg/L) as an independent predictor of worse outcome [ 56 ], although data in this field remain controversial and further studies are needed.…”