Abstract
BackgroundHyperbilirubinemia after heart valve surgery (HVS) with cardiopulmonary bypass is frequently observed and associated with worse outcomes. We investigated the characteristics and prognosis of patients with severe hyperbilirubinemia after HVS for rheumatic heart disease (RHD) to identify the clinical outcomes and potential risk factors.MethodsBetween 2015 and 2018, patients who underwent HVS in the cardiac surgery intensive care unit of our hospital were retrospectively screened. Risk factors for acute kidney injury (AKI), the requirement for continuous renal replacement therapy (CRRT), and in-hospital and long-term mortality were identified by univariate and multivariate analyses. The patient survival proportion was graphically presented with the Kaplan–Meier method.ResultsA total of 149 patients who underwent HVS for RHD and had severe postoperative hyperbilirubinemia were included. Of the included patients, 80.5% developed postoperative AKI, and 18.1% required CRRT. The in-hospital mortality was 30.2%. Backward logistic regression analysis showed that the time to peak TB concentration (odds ratio [OR] 1.557, 95% confidence interval [CI] 1.259–1.926; P < 0.001) and advanced AKI (stage 2 and 3 AKI) (OR 19.408, 95% CI 6.553–57.482; P < 0.001) were independent predictors for in-hospital mortality. The cutoff value of the time to peak TB levels for predicting in-hospital mortality was 5 postoperative days.ConclusionsSevere postoperative hyperbilirubinemia is a life-threatening complication in patients who undergo HVS for RHD. Patients whose bilirubin levels continued to increase past the 5th postoperative day and who had advanced AKI (stages 2 and 3) were associated with a higher risk of mortality.
Highlights
Hyperbilirubinemia after heart valve surgery (HVS) with cardiopulmonary bypass is frequently observed and associated with worse outcomes
To explore of the characteristics, prognosis, and risk factors for in-hospital and long-term mortality is helpful for clinicians understand the prognosis for patients with severe postoperative hyperbilirubinemia, which is useful for patient consultation as well as decision making
Risk factors for postoperative acute kidney injury (AKI) and CRRTOur present study found that age and preoperative Hb were independent risk factors for AKI, which was consistent with previous studies in cardiac surgery patients [25,26,27]
Summary
Hyperbilirubinemia after heart valve surgery (HVS) with cardiopulmonary bypass is frequently observed and associated with worse outcomes. We investigated the characteristics and prognosis of patients with severe hyperbilirubinemia after HVS for rheumatic heart disease (RHD) to identify the clinical outcomes and potential risk factors. Previous studies indicated that transient mild hyperbilirubinemia was usually associated with a favorable prognosis, while late-occurring severe hyperbilirubinemia (5 times the normal upper limit) was associated with high mortality and morbidity for patients with cardiac surgery [10]. This is mainly because mild hyperbilirubinemia is usually reversible and temporary, which may be caused by hemolysis, hepatic hypoperfusion, gaseous microemboli, and the necessity for blood transfusions during CPB. To date, there are relatively few reports on the characteristics and outcomes of patients with severe postoperative hyperbilirubinemia after HVS for RHD
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