Abstract
Aims The aim of this study was to assess the prognostic value of the serum total bilirubin (TBIL) level in pediatric patients with sepsis-associated liver injury (SALI). Methods We performed a retrospective study of patients with SALI admitted to the pediatric intensive care unit (PICU) in Shanghai Children's Hospital between December 2012 and December 2015. Serum TBIL concentration was determined within 72 h after PICU admission. Results Seventy-two patients with SALI were included in this study. The overall mortality rate was 36.1% (26/72). The serum levels of TBIL of patients were significantly higher in the nonsurvivor group than the survivor group. Cox regression analysis indicated that the elevated serum TBIL level within 72 hours after admission was an independent risk factor of mortality in patients with SALI. Furthermore, the area under the receiver-operating characteristic (ROC) curve (AUC) for TBIL was 0.736 (95% confidence interval (CI): 0.614–0.858, P=0.001), in which the optimal cut-off value was 64.5 μmol/L. The combined index named “TBIL” and “TBA” showed an AUC of 0.745 (0.626–0.865) for predicting the prognosis in patients with SALI. In addition, the Kaplan–Meier curve indicated that the 28-day survival rate was significantly lower in patients with higher serum TBIL levels (≥64.5 μmol/L) or higher value of TBIL and TBA (≥−0.8902). Conclusions Elevated serum TBIL level is associated with poor outcomes in pediatric SALI.
Highlights
Sepsis is defined as life-threatening organ dysfunction caused by a deregulated host response to infection [1]
Liver dysfunction contributes to the metabolic derangements of critical illness and usually is associated with poor prognosis [3,4,5]. e incidence of sepsis-associated liver injury (SALI) in the adult is about 34.7% [6]
CNS: central nervous system; CRRT: continuous renal replacement therapy; MAP: mean arterial pressure; PaO2/FiO2: the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2); sCr: serum creatinine; BUN: blood urea nitrogen; Lac: lactate; PLT: platelet. ∗Indicated that data were treated with Ln processing
Summary
Sepsis is defined as life-threatening organ dysfunction caused by a deregulated host response to infection [1]. The mortality rate for sepsis has declined over the past decade, it remains high in critically ill patients [2]. E liver plays a key role in regulation of host immune response to sepsis for clearing bacteria and toxins, which causes inflammation, immunosuppression, and liver damage [3]. Liver dysfunction contributes to the metabolic derangements of critical illness and usually is associated with poor prognosis [3,4,5]. E incidence of sepsis-associated liver injury (SALI) in the adult is about 34.7% [6]. SALI is a significant predictive sign of poor prognosis in adult patients with sepsis [6]. The prognostic prediction of pediatric SALI remains the little information available
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