Hyperbilirubinemia: a risk factor for infection in the surgical intensive care unit
Erin Field1, H Mathilda Horst, Ilan S Rubinfeld
1Department of Surgery, Henry Ford Hospital, Detroit, MI, USA. efield1@hfhs.org
Background:
Hyperbilirubinemia in intensive care unit (ICU) patients is common. We hypothesized that hyperbilirubinemia in the surgical ICU predisposes patients to infection.
Methods:
Patients with bilirubin < or = 3 mg/dL were compared to patients with bilirubin > 3 mg/dL. We then compared the low bilirubin patients to high bilirubin patients who developed infection after their hyperbilirubinemia.
Results:
There were 1,620 infections in 5,712 patients with low bilirubin (28%), compared with 284 in 409 patients in the high bilirubin group (69%, P < .001). After removing the patients in whom hyperbilirubinemia developed after infection, we found infection in 156 of 281 remaining patients (56%, P < .001). This group had a 3-fold increased risk of infection compared with low bilirubin (odds ratio [OR] 3.17, 95% confidence interval [CI] 2.48-4.03, P < .001).
Conclusions:
There is an increased susceptibility to infection among jaundiced surgical ICU (SICU) patients that persists even when sepsis-related hyperbilirubinemia patients are excluded.
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