Jaundice in critical illness: promoting factors of a concealed reality

Abstract 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.