• Magali Bisbal, Michael Darmon, Colombe Saillard, Vincent Mallet, Charlotte Mouliade, Virginie Lemiale, Dominique Benoit, Frederic Pene, Achille Kouatchet, Alexandre Demoule, Francois Vincent, Martine Nyunga, Fabrice Bruneel, Christine Lebert, Anne Renault, Anne-Pascale Meert, Rebecca Hamidfar, Merce Jourdain, Elie Azoulay, and Djamel Mokart.
• Intensive Care Unit, Institut Paoli Calmettes, Marseille, France. Electronic address: bisbalm@ipc.unicancer.fr.
• J Crit Care. 2021 Apr 1; 62: 88-93.

PurposeHyperbilirubinemia is frequent in patients with hematological malignancies admitted to the intensive care unit (ICU). Literature about hepatic dysfunction (HD) in this context is scarce.MethodsWe investigated the prognostic impact of HD analyzing a prospective multicenter cohort of 893 critically ill hematology patients. Two groups were defined: patients with HD (total bilirubin ≥33 μmol/L at ICU admission) and patients without HD.ResultsTwenty one percent of patients were found to have HD at ICU admission. Cyclosporine, antimicrobials before ICU admission, abdominal symptoms, ascites, history of liver disease, neutropenia, increased serum creatinine and myeloma were independently associated with HD. Etiology remained undetermined in 73% of patients. Hospital mortality was 56.3% and 36.3% respectively in patients with and without HD (p < 0.0001). Prognostic factors independently associated with hospital mortality in HD group were, performance status >1 (OR = 2.07, 95% CI = 1.49-2.87, p < 0.0001), invasive mechanical ventilation (OR = 3.92, 95% CI = 2.69-5.71, p < 0.0001), renal replacement therapy (OR = 1.74, 95% CI = 1.22-2.47, p = 0.002), vasoactive drug (OR = 1.81, 95% CI = 1.21-2.71, p = 0.004) and SOFA score without bilirubin level at ICU admission (OR = 1.09, 95% CI = 1.04-1.14, p < 0.0001).ConclusionsHD is common, underestimated, infrequently investigated, and is associated with impaired outcome in critically ill hematology patients. HD should be considered upon ICU admission and managed as other organ dysfunctions.Copyright © 2020. Published by Elsevier Inc.

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