Dataset Information

Direct bilirubin as a prognostic biomarker in enteric fistula patients complicated with sepsis: a case-control study.

ABSTRACT:

Objective

The objective of this study was to evaluate the predictive value of serial bilirubin determinations for mortality in enteric fistula (EF) patients complicated with sepsis.

Methods

From January 1st, 2012 to January 13rd, 2013, a prospective study enrolling 162 patients was performed. Patients were divided into the survivors group (n = 119) and non-survivors group (n = 43) according to 28-day outcomes. Laboratory variables on day 0, day 3 and day 7 after admission were recorded. DB0 was defined as serum direct bilirubin (DB) value in admission, while ?DB3 as the changes from DB3 to DB0. The definition applied to other parameters. The results were validated in an independent cohort of 116 patients.

Results

Compared with survivors, non-survivors had significantly higher DB7 (23.1 ± 10.6 vs. 11.2 ± 1.1, P < 0.001) and procalcitonin (PCT7) (5.2 ± 2.8 vs. 1.7 ± 0.3 P = 0.006). ROC analysis showed that DB7 > 12.8 ?mol/L and ?DB7 > 7.3 ?mol/L were reliable predictors (DB7: 86.4% sensitivity, 88.6% specificity (area under the curve (AUC): 0.881, P < 0.001; ?DB7: 84.4% sensitivity, 85.1% specificity, AUC: 0.865, P < 0.001) for mortality.The combination form (DB7 > 12.8 ?mol/L + ?PCT7 < 5.3 ng/ml) had greatest predictive value (AUC: 0.894, P < 0.001). Their predictive values were confirmed in the validation cohort.

Conclusions

Serum direct bilirubin was a reliable predictor for mortality in enteric fistula patients, which should be paid close attention in the critical care.

SUBMITTER: Wu Y

PROVIDER: S-EPMC4307463 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Direct bilirubin as a prognostic biomarker in enteric fistula patients complicated with sepsis: a case-control study.

Wu Yin Y Ren Jianan J Wang Gefei G Gu Guosheng G Zhou Bo B Ding Chao C Li Guanwei G Liu Song S Wu Xiuwen X Chen Jun J Li Jieshou J

International journal of clinical and experimental medicine 20141215 12

<h4>Objective</h4>The objective of this study was to evaluate the predictive value of serial bilirubin determinations for mortality in enteric fistula (EF) patients complicated with sepsis.<h4>Methods</h4>From January 1st, 2012 to January 13rd, 2013, a prospective study enrolling 162 patients was performed. Patients were divided into the survivors group (n = 119) and non-survivors group (n = 43) according to 28-day outcomes. Laboratory variables on day 0, day 3 and day 7 after admission were rec ...[more]

PMID: 25664016

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Project description:IntroductionAlarming outcomes have been reported following infected endovascular aortic aneurysm repair (EVAR) device explantation. Infected fenestrated EVAR (FEVAR) exposes patients to even worse procedural risks.ReportA 67 year old man with a prior history of FEVAR presented with impaired general condition, abdominal and back pain, and increased C reactive protein. Computed tomography angiography revealed a collection around the aortic graft bifurcation and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed increased FDG uptake at this level, confirmed by labelled white blood cells, all favouring graft infection. A thoracophrenolumbotomy was performed and revealed an aorto-enteric fistula which was treated by small bowel resection. The left renal artery was transected at the distal end of the bridging stent and a thoracorenal bypass was performed. The thoracic aorta was cross clamped above the coeliac trunk for complete graft excision. Meanwhile, the right kidney was perfused with 4°C Ringer lactate solution. In situ reconstruction was accomplished with a bifurcated antimicrobial graft sutured below the superior mesenteric artery with re-implantation of the right renal artery. The patient was left with a laparostomy for definitive abdominal closure, restoration of the digestive tract, and omental wrap 72 hours later. Broad spectrum antibiotic therapy was initiated peri-operatively and reduced to sulfamethoxazole/trimethoprim for a total duration of six weeks after one sample was positive for Moraxella osloensis. Eleven months later, the patient was free from re-infection, with no fever or inflammatory syndrome.DiscussionTotal explantation of stent grafts with tissue debridement and post-operative antibiotic therapy is the gold standard when dealing with infected EVAR. As with type IV thoraco-abdominal aneurysm open repair, FEVAR device explantation requires additional protective measures to prevent visceral ischaemia and renal impairment. In agreement with the European Society for Vascular Surgery guidelines, such patients should be referred to dedicated vascular centres with expertise in surgical repair, anaesthetics, and post-operative intensive care.

Dataset Information

Direct bilirubin as a prognostic biomarker in enteric fistula patients complicated with sepsis: a case-control study.

Objective

Methods

Results

Conclusions

Publications

Direct bilirubin as a prognostic biomarker in enteric fistula patients complicated with sepsis: a case-control study.

Similar Datasets

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