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Association of serum total bilirubin and potential predictors with mortality in acute respiratory failure: A retrospective cohort study

  • Author Footnotes
    1 Joint first authors: Zhishen Ruan, Dan Li.
    Zhishen Ruan
    Footnotes
    1 Joint first authors: Zhishen Ruan, Dan Li.
    Affiliations
    Shandong Traditional Chinese Medicine University, Ji Nan, China
    Search for articles by this author
  • Author Footnotes
    1 Joint first authors: Zhishen Ruan, Dan Li.
    Dan Li
    Footnotes
    1 Joint first authors: Zhishen Ruan, Dan Li.
    Affiliations
    Shandong Traditional Chinese Medicine University, Ji Nan, China
    Search for articles by this author
  • Xianhai Chen
    Correspondence
    Corresponding author at: Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42 Wenhua West Road, Ji Nan city, Shandong Province, People's Republic of China
    Affiliations
    Shandong Traditional Chinese Medicine University, Ji Nan, China

    Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji Nan, China
    Search for articles by this author
  • Zhanjun Qiu
    Correspondence
    Corresponding author at: Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42 Wenhua West Road, Ji Nan city, Shandong Province, People's Republic of China
    Affiliations
    Shandong Traditional Chinese Medicine University, Ji Nan, China

    Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji Nan, China
    Search for articles by this author
  • Author Footnotes
    1 Joint first authors: Zhishen Ruan, Dan Li.

      Abstract

      Background

      Total serum bilirubin (TBIL) levels are a risk factor in critically ill patients. However, the relationship between the dynamics of TBIL and the prognosis of acute respiratory failure (ARF) patients is unclear.

      Objectives

      This study aimed to investigate the impact of different levels of TBIL during hospitalization on mortality in ARF patients.

      Methods

      This study used a retrospective cohort study. We extracted information on ARF patients from the Medical Information Bank for Intensive Care (MIMIC)-III (version 1.4). We used propensity score matching (PSM) to adjust for the level of potential baseline-level differences between groups. Cox regression was used to analyze mortality risk factors in patients with ARF. Subgroup analysis was used to explore special populations.

      Results

      2673 patients were included in the study, and 19.7% developed hyperbilirubinemia (TBIL ≥ 2 mg/dL) during their hospitalization. After PSM, multivariate Cox regression showed a 50% and 135% increased risk of death for a maximum value of TBIL ≥ 5 mg/dL and minimum value of TBIL ≥ 2 mg/dL during hospitalization, respectively, compared to the control population. In addition, age ≥ 65 years, previous comorbid malignancies, respiratory rate ≥ 22 beats/min, SpO2 ≥ 95, BUN ≥ 20 mg/dL, lactate ≥ 5 mmol/L, platelet < 100 * 10 ^ 9/L were independent risk factors for 1-year mortality in ARF patients. Subgroup analysis showed that high bilirubin had a greater effect on patients aged less than 65 years (P for interaction < 0.05).

      Conclusions

      Hyper TBIL (TBIL max ≥ 5 mg/dL or TBIL min ≥ 2 mg/dL) was an independent risk factor for 1-year mortality in patients with ARF. This study suggests that clinicians should be aware of TBIL levels and intervene early in these patients.

      Keywords

      Abbreviations:

      Acute respiratory failure (ARF), Intensive care unit (ICU), Acute respiratory distress syndrome (ARDS), Total serum bilirubin (TBIL), Medical Information Bank for Intensive Care (MIMIC), White blood cell (WBC), Blood urea nitrogen (BUN), Peripheral oxygen saturation (SpO2), Congestive heart failure (CHF), Propensity score matching (PSM)
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