This article is more than 5 years old. Information may no longer be current.

Patients with jaundice, hypoxic hepatitis experienced increased mortality, more complications

Patients with hypoxic hepatitis who developed jaundice were at increased risk for death and experienced more complications than patients without jaundice in a recent study.

Researchers screened 175 patients with hypoxic hepatitis (HH) for new-onset jaundice, diagnosed in those with bilirubin levels higher than 3 mg/dL, and compared 1-year survival rates and incidence of infection and hepatic, gastrointestinal, renal and cardiopulmonary complications between those who did and did not develop HH.

Jaundice occurred in 63 participants within a median of 2 days after HH onset, with a median duration of 6 days among those who survived the acute event. Illness was generally more severe among patients with jaundice, with significantly greater sequential organ failure assessment (SOFA) (12 vs. 10, P=.003)and simplified acute physiology score II (SAPS II) (72 vs. 55, P<.001) results than those without jaundice. Development of jaundice was associated with greater SAPS II (OR=1,021; 95% CI, 1,003-1,038) and peak international normalized ratio (INR) levels (OR=1,413; 95% CI, 1,062-1,879) via multivariate analysis.

Patients with jaundice were more likely to require mechanical ventilation (P=.018), vasopressor treatment (P=.034) and renal replacement therapy (P=.036). They also had a significantly lower survival rate at 1 year (8% of patients compared with 25%, P<.05), but intensive care unit mortality was similar between groups (64% of patients with jaundice compared with 53%, P=.17). Death due to septic shock was significantly more common among jaundiced patients (36% compared with 20%, P=.035).

Investigators observed associations between jaundice and an increased incidence of complications, with 54% of patients with jaundice experiencing at least one compared with 35% of those without (P=.014). Infection (P=.001), pneumonia (P=.002), renal (P=.002) and GI complications (P=.022) were all more common among patients with jaundice.

“New onset of jaundice is a frequent finding in critically ill patients with HH, and is associated with an increased number of complications and increased 1-year mortality,” the researchers wrote. “Severity of illness and degree of hepatic injury during the acute phase of HH are the main triggers of jaundice. Future studies should evaluate whether preventive or therapeutic strategies are able to reduce the high rate of jaundice and its associated complications in patients with HH.”