Etiologic factors of jaundice in severely ill patients. A retrospective study in patients admitted to an intensive care unit with severe trauma or with septic intra-abdominal complications following surgery and without evidence of bile duct obstruction

Abstract

In order to understand the pathophysiology of jaundice in severely ill patients, we have examined several possible promoting factors in a retrospective study of 86 patients with multiple organ failure admitted to an intensive care unit (ICU). Patients with bile duct obstruction were excluded from this study. Cholestatic jaundice had developed in 19 of 54 patients after trauma and in 20 of 32 patients after septic intra-abdominal complications. No differences were found between the icteric and non-icteric groups of patients with regard to median age, sex distribution, duration of stay in the ICU, number of operations, utilization of gaseous and/or intravenously administered anaesthetics and lipid, and administration of potential hepatotoxic drugs. Twenty-six of 39 icteric patients had a normal renal function. However, a significantly higher number of blood transfusions was found in the icteric as compared to the non-icteric patients. The higher number of blood transfusions and the incidence of initial shock in the icteric trauma patients were probably related to the higher injury severity score. Furthermore, sepsis was found significantly more frequently in the icteric trauma patients, while the number of organ failures when the presence of jaundice was not accounted for was the same in both groups. Nevertheless, the severity of jaundice correlated well with the increasing number of failing organs and the increasing mortality. From these findings we can therefore conclude that jaundice occurring in patients with multiple organ failure is usually not due to the administration of potential hepatotoxic drugs. However, the number of blood transfusions may be an important associated factor.(ABSTRACT TRUNCATED AT 250 WORDS)