Aetiology and Prognostic Implication of Severe Jaundice in Surgical Trauma Patients

Abstract

Background: Pronounced postoperative jaundice occurs not infrequently in trauma patients. The aim of this study was to elucidate the implication of early, pronounced jaundice (serum-bilirubin >100 μmol·1̄¹) for 30-day survival of such patients. Methods: From 1995 through 2001, 53 surgical trauma patients developing pronounced postoperative jaundice were identified. Nine were excluded from the study because of major hepatobiliary injury or pre-existing liver disease. The clinical course and laboratory chemistry profiles of the remaining 44 patients were analysed. Results: Thirty-one patients survived and 13 died within 30 days of trauma. Non-survivors had higher age, higher injury severity score (ISS) and lower probability of survival (PS) (P ≺ 0.05) than survivors. ISS averaged 34 in survivors and 45 in non-survivors. Survivors and non-survivors received a mean of 46 (range 10-97) and 55 units of blood (range 11-128), respectively (P = 0.366). Systematic hypotension, local infections and sepsis were common in both groups. Bilirubin levels peaked around the 11th day in survivors (median 189 μmol·1̄¹). In non-survivors, serum bilirubin values rose progressively, reaching maximum levels at time of death (median 231 μmol·1̄¹). These patients died in a setting of sepsis and multiple organ failure. Conclusion: Large endogenous production of bilirubin because of rapid breakdown of transfused and extravasated blood can cause pronounced jaundice in multitransfused trauma patients. In such patients, serum bilirubin rising > 100 μmol·1̄¹ does not by itself signal poor outcome. However, progressive pronounced jaundice outlasting the trauma incident by 10-12 days portends fatal outcome for the patient.

Key words:

• Bilirubin
• blood transfusion
• intensive care unit
• jaundice
• trauma

Additional information

Notes on contributors

K.J. Labori

Labori KJ, Bjørnbeth BA, Ræder MG. Aetiology and Prognostic Implication of Severe Jaundice in Surgical Trauma Patients. Scand J Gastroenterol 2003;38:102-108.

B.A. Bjørnbeth

Labori KJ, Bjørnbeth BA, Ræder MG. Aetiology and Prognostic Implication of Severe Jaundice in Surgical Trauma Patients. Scand J Gastroenterol 2003;38:102-108.

M.G. Ræder

Labori KJ, Bjørnbeth BA, Ræder MG. Aetiology and Prognostic Implication of Severe Jaundice in Surgical Trauma Patients. Scand J Gastroenterol 2003;38:102-108.