Jaundice in critical illness: promoting factors of a concealed reality

被引:93
作者
Brienza, N
Dalfino, L
Cinnella, G
Diele, C
Bruno, F
Fiore, T
机构
[1] Univ Bari, Emergency & Organ Transplantat Dept, Anaesthesia & Intens Care Unit, I-70124 Bari, Italy
[2] Univ Foggia, Anaesthesia & Intens Care Unit, Foggia, Italy
关键词
hepato-splanchnic haemodynamic; ICU jaundice; liver dysfunction; PEEP; sepsis; shock;
D O I
10.1007/s00134-005-0023-3
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective:In critical illness, liver dysfunction (LD) is associated with a poor outcome independently of other organ dysfunctions. Since strategies to support liver function are not available, a timely and accurate identification of factors promoting LD may lead to prevention or attenuation of its consequences. The aim of this study was to assess risk factors for LD in critically ill patients. Design:Prospective, observational study.Setting: A multidisciplinary intensive care unit (ICU) of a university hospital.Patients: All patients consecutively admitted over a 6-month period. Intervention: None. Measurements and results: LD was defined as serum bilirubin levels >= 2 mg/dl and lasting for at least 48 h. Out of 283 patients, 141 matched inclusion criteria. Forty-four patients (31.2%) showed LD (LD group), while 97 (68.8%) were included in control group (C group). A binomial analysis showed that LD occurrence was associated with moderate (odds ratio [OR] 3.11; p = 0.04) and severe shock (OR 3.46; p = 0.05), sepsis (OR 3.03; p = 0.04), PEEP ventilation (OR 4.25; p = 0.006), major surgery (OR 4.03; p = 0.03), and gram-negative infections (OR 3.94; p = 0.002). In stepwise multivariate analysis, the single independent predictive factors of LD resulted in severe shock (p = 0.002), sepsis (p = 0.03), PEEP ventilation (p = 0.04), and major surgery (p = 0.05).Conclusions:In critically ill patients jaundice is common, and severe shock states, sepsis, mechanical ventilation with PEEP and major surgery are critical risk factors for its onset. Since there is no specific treatment, prompt resuscitation, treatment of sepsis and meticulous supportive care will likely reduce its incidence and severity.
引用
收藏
页码:267 / 274
页数:8
相关论文
共 36 条
  • [1] PRESSURE-FLOW ANALYSIS OF PORTAL-VEIN AND HEPATIC-ARTERY INTERACTIONS IN PORCINE LIVER
    AYUSE, T
    BRIENZA, N
    ODONNELL, CP
    ROBOTHAM, JL
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1994, 267 (04): : H1233 - H1242
  • [2] ALTERATIONS IN LIVER HEMODYNAMICS IN AN INTACT PORCINE MODEL OF ENDOTOXIN-SHOCK
    AYUSE, T
    BRIENZA, N
    REVELLY, JP
    ODONNELL, CP
    BOITNOTT, JK
    ROBOTHAM, JL
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1995, 268 (03): : H1106 - H1114
  • [3] AMERICAN-COLLEGE OF CHEST PHYSICIANS SOCIETY OF CRITICAL CARE MEDICINE CONSENSUS CONFERENCE - DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS
    BONE, RC
    BALK, RA
    CERRA, FB
    DELLINGER, RP
    FEIN, AM
    KNAUS, WA
    SCHEIN, RMH
    SIBBALD, WJ
    ABRAMS, JH
    BERNARD, GR
    BIONDI, JW
    CALVIN, JE
    DEMLING, R
    FAHEY, PJ
    FISHER, CJ
    FRANKLIN, C
    GORELICK, KJ
    KELLEY, MA
    MAKI, DG
    MARSHALL, JC
    MERRILL, WW
    PRIBBLE, JP
    RACKOW, EC
    RODELL, TC
    SHEAGREN, JN
    SILVER, M
    SPRUNG, CL
    STRAUBE, RC
    TOBIN, MJ
    TRENHOLME, GM
    WAGNER, DP
    WEBB, CD
    WHERRY, JC
    WIEDEMANN, HP
    WORTEL, CH
    [J]. CRITICAL CARE MEDICINE, 1992, 20 (06) : 864 - 874
  • [4] RELATION OF PORTAL HEMODYNAMICS TO CARDIAC-OUTPUT DURING MECHANICAL VENTILATION WITH PEEP
    BREDENBERG, CE
    PASKANIK, AM
    [J]. ANNALS OF SURGERY, 1983, 198 (02) : 218 - 222
  • [5] REGIONAL CONTROL OF VENOUS RETURN - LIVER BLOOD-FLOW
    BRIENZA, N
    AYUSE, T
    ODONNELL, CP
    PERMUTT, S
    ROBOTHAM, JL
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (02) : 511 - 518
  • [6] EFFECTS OF PEEP ON LIVER ARTERIAL AND VENOUS-BLOOD FLOWS
    BRIENZA, N
    REVELLY, JP
    AYUSE, T
    ROBOTHAM, JL
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (02) : 504 - 510
  • [7] Monitoring the hepato-splanchnic region in the critically ill patient - Measurement techniques and clinical relevance
    Brinkmann, A
    Calzia, E
    Trager, K
    Radermacher, P
    [J]. INTENSIVE CARE MEDICINE, 1998, 24 (06) : 542 - 556
  • [8] Chung Chuhan, 2002, Clin Liver Dis, V6, P1067, DOI 10.1016/S1089-3261(02)00057-0
  • [9] Hepatic response to sepsis: Interaction between coagulation and inflammatory processes
    Dhainaut, JF
    Marin, N
    Mignon, A
    Vinsonneau, C
    [J]. CRITICAL CARE MEDICINE, 2001, 29 (07) : S42 - S47
  • [10] Characteristics and outcomes in adult patients receiving mechanical ventilation -: A 28-day international study
    Esteban, A
    Anzueto, A
    Frutos, F
    Alía, I
    Brochard, L
    Stewart, TE
    Benito, S
    Epstein, SK
    Apezteguía, C
    Nightingale, P
    Arroliga, AC
    Tobin, MJ
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 287 (03): : 345 - 355