Jaundice in Adult in-Patients at a Tertiary General Hospital

Abstract

Objective: The aim of the study is to investigate the “new-onset jaundice” incidence, map of causes, approaching method, and risk factors for treatment failure in adult in-patients at a tertiary general hospital as Cho Ray Hospital, Ho Chi Minh City, Viet Nam. Method: Retrospective study was done on 416 jaundice patients administered over 38 continuous days. Laboratory tests investigated were total bilirubin, direct bilirubin, AST, ALT, AST/ALT ratio, GGT, AP, bilirubin and urobilinogen in urine. Jaundice was defined as total bilirubin ≥ 2.5 mg/dL, direct bilirubin jaundice defined as direct bilirubin > 2 mg/dL and D/T percentage > 60%, the severity of AST, ALT evaluated according to Common Terminology Criteria for Adverse Events, AST/ALT ratio, and bilirubin, urobilinogen in urine. Outcome of treatment were classified in two groups: failure (dead or discharge due to worse status) and success. Descriptive statistics and analytic statistics were applied, mono-variable analysis and multinomial logistic regression to find out the independent risk factors for treatment failure. Results: The incidence of “new-onset” jaundice in adult patients was 11 ± 5 person/day. The map of jaundice included 3 phases as pre-heaptic 13.7%, in-hepatic 58.2%, and post-hepatic 22.8%. Pancreatic and biliary tract diseases accounted 17.1%, then cirrhosis 16.3%, liver tumor 14.7%, hepatitis 8.9%, sepsis 8.9%, hematology diseases 7.9%, and cardiac diseases 7.5%. A guide for approaching causes of jaundice basing on 7 parameters as total bilirubin, D/T percentage, severity of ALT, AST/ALT ratio, severity of GGT, and bilirubin and urobilinogen in urine was established. The overall mortality was 7.5% (31/416), sepsis had highest death rate of 37.8% (14/37). Sepsis and AST/ALT ratio > 2 were the two independent risk factors of mortality. Conclusion: At tertiary hospital, jaundice is common sign in adult patient, diverse enormously in many clinical wards. The map of causes of jaundice completed all 3 phases: pre-hepatic, intra-hepatic and post-hepatic phase. Drug hepatitis jaundice was an important cause in hepatitis. Sepsis had highest mortality in adult jaundice patients. Combination of 7 criteria as total bilirubin, the D/T percentage, ALT severity, AST/ALT ratio, GGT, bilirubin and urobilinogen in urine gave the guide for approaching to jaundice. Sepsis and AST/ALT ratio > 2 were independent risk factors of treatment failure. The survey of jaundice in adult in-patients in a tertiary general government hospital gave the full picture for this common pathological sign.