HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, M.-J. Articles by Chu, S.-H. Search for Related Content PubMed PubMed Citation Articles by Wang, M.-J. Articles by Chu, S.-H.

J Thorac Cardiovasc Surg 1994;108:429-436
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Hyperbilirubinemia after cardiac operation: Incidence, risk factors, and clinical significance

Taipei, Taiwan

Received for publication Aug. 24, 1993. Accepted for publication Jan. 9, 1994. Address for reprints: Shu-Hsun Chu, MD, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Rd., Taipei, Taiwan.

Abstract

Three hundred and two consecutive patients who had undergone cardiac operation for various cardiac lesions were studied prospectively to evaluate the incidence, risk factors, and the associated mortality of postoperative hyperbilirubinemia after cardiopulmonary bypass. Concentrations of the serum total (conjugated and unconjugated) bilirubin, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, albumin, globulin, and serum haptoglobin were measured before the operation and again on the first, second, and seventh postoperative days. Postoperative hyperbilirubinemia was defined as occurrence of a serum total bilirubin concentration of more than 3 mg/dl in any measurement during the postoperative period. Logistic regression was done to identify possible risk factors for postoperative hyperbilirubinemia. Overall incidence of postoperative hyperbilirubinemia was 35.1%; the incidence of postoperative hyperbilirubinemia was higher in patients whose valves were replaced with mechanical prostheses than in those without prostheses (p < 0.00001). In patients with postoperative hyperbilirubinemia, 70% of the increase of total bilirubin on the first postoperative day came about from an increase in unconjugated bilirubin. Serum haptoglobin decreased significantly at the same time (p < 0.01). Development of the postoperative hyperbilirubinemia was associated with a higher mortality (5.6% versus 0.5%, p < 0.01) and higher frequency of use of intraaortic balloon counterpulsation, especially for patients in whom the highest postoperative total bilirubin occurred after the first 2 days. The numbers of valves replaced, preoperative right atrial pressure, and preoperative total bilirubin concentration are the significant risk factors that, in combination, correctly predict the occurrence of postoperative hyperbilirubinemia in 80% of the patients. We concluded that postoperative hyperbilirubinemia results mainly from an increase in unconjugated bilirubin and is associated with higher mortality, especially for patients in whom highest postoperative total bilirubin occurred late after operation. Patients with the higher preoperative right atrial pressure and total bilirubin level who then underwent multiple valve replacement procedures are at greater risk for development of postoperative hyperbilirubinemia. (J THORAC CARDIOVASC SURG 1994;108:429-36)

This article has been cited by other articles:

				R. K. P. Adluri, A. V. Singh, J. Skoyles, A. Robins, A. Hitch, M. Baker, and I. M. Mitchell The effect of fenoldopam and dopexamine on hepatic blood flow and hepatic function following coronary artery bypass grafting with hypothermic cardiopulmonary bypass Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 988 - 994. [Abstract] [Full Text] [PDF]

				R.-B. Hsu, F.-Y. Lin, R. J. Chen, N.-K. Chou, W.-J. Ko, N.-H. Chi, S.-S. Wang, and S.-H. Chu Incidence, risk factors, and prognosis of postoperative hyperbilirubinemia after heart transplantation Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 917 - 922. [Abstract] [Full Text] [PDF]

				T. Patila, S. Kukkonen, A. Vento, V. Pettila, and R. Suojaranta-Ylinen Relation of the Sequential Organ Failure Assessment Score to Morbidity and Mortality After Cardiac Surgery Ann. Thorac. Surg., December 1, 2006; 82(6): 2072 - 2078. [Abstract] [Full Text] [PDF]

				M. Mazzoni, R. De Maria, F. Bortone, M. Parolini, R. Ceriani, C. Solinas, V. Arena, and O. Parodi Long-Term Outcome of Survivors of Prolonged Intensive Care Treatment After Cardiac Surgery Ann. Thorac. Surg., December 1, 2006; 82(6): 2080 - 2087. [Abstract] [Full Text] [PDF]

				R. Ascione, S. Talpahewa, C. Rajakaruna, B. C. Reeves, A. T. Lovell, A. Cohen, and G. D. Angelini Splanchnic Organ Injury During Coronary Surgery With or Without Cardiopulmonary Bypass: A Randomized, Controlled Trial Ann. Thorac. Surg., January 1, 2006; 81(1): 97 - 103. [Abstract] [Full Text] [PDF]

				M. E. McSweeney, S. Garwood, J. Levin, M. R. Marino, S. X. Wang, D. Kardatzke, D. T. Mangano, and R. L. Wolman Adverse Gastrointestinal Complications After Cardiopulmonary Bypass: Can Outcome Be Predicted from Preoperative Risk Factors? Anesth. Analg., June 1, 2004; 98(6): 1610 - 1617. [Abstract] [Full Text] [PDF]

				K. Hashimoto, T. Sasaki, T. Hachiya, K. Onoguchi, H. Takakura, M. Oshiumi, and S. Takeuchi Superior hepatic mitochondrial oxidation-reduction state in normothermic cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., June 1, 2001; 121(6): 1179 - 1186. [Abstract] [Full Text] [PDF]

				A. Chandra, D. Gupta, K S. S. Saibaba, D. Dilip, S. Kola, and M. S. Naidu Hyperbilirubinemia After Cardiopulmonary Bypass: A Prospective Study Asian Cardiovasc Thorac Ann, March 1, 1999; 7(1): 3 - 8. [Abstract] [Full Text] [PDF]

				I. M. Mitchell Liver function after cardiopulmonary bypass in children J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 284 - 286. [Full Text]