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Verfasst von:Farag, Mina [VerfasserIn]   i
 Veres, Gábor [VerfasserIn]   i
 Szabó, Gábor [VerfasserIn]   i
 Ruhparwar, Arjang [VerfasserIn]   i
 Karck, Matthias [VerfasserIn]   i
 Arif, Rawa [VerfasserIn]   i
Titel:Hyperbilirubinaemia after cardiac surgery
Titelzusatz:the point of no return
Verf.angabe:Mina Farag, Gabor Veres, Gabor Szabó, Arjang Ruhparwar, Matthias Karck, Rawa Arif
E-Jahr:2019
Jahr:16 May 2019
Umfang:7 S.
Fussnoten:First published: 16 May 2019 ; Gesehen am 11.05.2020
Titel Quelle:Enthalten in: European Society of CardiologyESC heart failure
Ort Quelle:Chichester : Wiley, 2014
Jahr Quelle:2019
Band/Heft Quelle:6(2019), 4, Seite 694-700
ISSN Quelle:2055-5822
Abstract:Aims The occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post-operative heart failure is fairly common. We investigated the incidence, predictive value, and post-operative outcome of hyperbilirubinaemia after cardiac surgery in an effort to identify potential risk factors and significance on clinical outcome. Methods and results Between 2006 and 2016, 1272 (10.1%) out of 12 556 patients developed hyperbilirubinaemia, defined as bilirubin concentration >3 mg/dL, during post-operative course at our institution. All patients who were operated using cardiopulmonary bypass were included. Hepatic dysfunction was diagnosed preoperatively in 200 patients (15.7%), whereas mean model of end-stage liver disease score was 11.22 ± 4.99. Early mortality was 17.4% with age [hazard ratio (HR) 1.019, 95% confidence interval (CI) 1.008-1.029; P = 0.001], diabetes (HR 1.115, CI 1.020-1.220; P = 0.017), and emergent procedures (HR 1.315, CI 1.012-1.710) as multivariate predictors. Post-operative predictors were low-output syndrome (HR 3.193, 95% CI 2.495-4.086; P < 0.001), blood transfusion (HR 1.0, CI 1.0-1.0; P < 0.001), and time to peak bilirubin (HR 1.1, CI 1.0-1.1; P < 0.001). We found an increased correlation with mortality at 3.5 post-operative day as well as an optimal cut-off value for bilirubin of 5.35 mg/dL. A maximum bilirubin of 25.5 mg/dL was associated with 99% mortality. Survival analysis showed significantly decreased survival for patients who developed late, rather than early, hyperbilirubinaemia. Conclusions Post-operative hyperbilirubinaemia is a prevalent threat after cardiopulmonary bypass, associated with high early mortality. The timing and amount of peak bilirubin concentration are linked to the underlying pathology and are predictors of post-operative outcome. Patients with late development of steep hyperbilirubinaemia warrant meticulous post-operative care optimizing cardiac and end organ functions before reaching the point of no return.
DOI:doi:10.1002/ehf2.12447
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext ; Verlag: https://doi.org/10.1002/ehf2.12447
 Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ehf2.12447
 DOI: https://doi.org/10.1002/ehf2.12447
Datenträger:Online-Ressource
Sprache:eng
Sach-SW:Cardiopulmonary bypass
 Hyperbilirubinaemia
 Liver failure
 Low-output syndrome
K10plus-PPN:1697820816
Verknüpfungen:→ Zeitschrift

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