The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis
Abstract Background Hyperbilirubinemia following cardiac surgery is a common phenomenon and is of emerging interest in prognostic factor research. This systematic review and meta-analysis evaluated the association between post-operative hyperbilirubinemia (PH) and mortality and morbidity in cardiac...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-022-01870-2 |
| _version_ | 1811253591004938240 |
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| author | Dev Raveendran Jahan C. Penny-Dimri Reny Segal Julian A. Smith Mark Plummer Zhengyang Liu Luke A. Perry |
| author_facet | Dev Raveendran Jahan C. Penny-Dimri Reny Segal Julian A. Smith Mark Plummer Zhengyang Liu Luke A. Perry |
| author_sort | Dev Raveendran |
| collection | DOAJ |
| description | Abstract Background Hyperbilirubinemia following cardiac surgery is a common phenomenon and is of emerging interest in prognostic factor research. This systematic review and meta-analysis evaluated the association between post-operative hyperbilirubinemia (PH) and mortality and morbidity in cardiac surgery patients. Methods Ovid Medline and Ovid Embase were searched from inception to July 2020 for studies evaluating the prognostic significance of PH following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each study and pooled using random effects inverse variance modelling to assess in-hospital mortality. Standardised mean differences were pooled to assess Intensive Care Unit (ICU) and hospital length of stay (LOS). Qualitative analysis was performed to assess ventilation requirements and long-term mortality. Meta-regression was used to assess inter- and intra-study heterogeneity. Results 3251 studies satisfied the selection criteria, from which 12 studies incorporating 3876 participants were included. PH significantly predicted in-hospital mortality with a pooled OR of 7.29 (95% CI 3.53, 15.09). Multiple pre-defined covariates contributed to the prognostic significance of PH, however only aortic cross-clamp time (p < 0.0001) and number of transfusions (p = 0.0001) were significant effect modifiers. PH significantly predicted both ICU LOS (Mean difference 1.32 [95% CI 0.04–2.6]) and hospital LOS (Mean difference 1.79 [95% CI 0.36–3.21]). Qualitative analysis suggested PH is associated with increased post-operative ventilation requirements and reduced long-term survival rates. Conclusions Hyperbilirubinemia is a cost-effective, widely available prognostic marker of adverse outcomes following cardiac surgery, albeit with residual sources of heterogeneity. |
| first_indexed | 2024-04-12T16:53:20Z |
| format | Article |
| id | doaj.art-012998bb0b7d4f07af25aa815083cc2f |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-12T16:53:20Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-012998bb0b7d4f07af25aa815083cc2f2022-12-22T03:24:19ZengBMCJournal of Cardiothoracic Surgery1749-80902022-05-0117111310.1186/s13019-022-01870-2The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysisDev Raveendran0Jahan C. Penny-Dimri1Reny Segal2Julian A. Smith3Mark Plummer4Zhengyang Liu5Luke A. Perry6Department of Anaesthesia and Pain Management, Royal Melbourne HospitalDepartment of Surgery, School of Clinical Science, Monash UniversityDepartment of Anaesthesia and Pain Management, Royal Melbourne HospitalDepartment of Surgery, School of Clinical Science, Monash UniversityCentre for Integrated Critical Care, University of MelbourneDepartment of Anaesthesia and Pain Management, Royal Melbourne HospitalDepartment of Anaesthesia and Pain Management, Royal Melbourne HospitalAbstract Background Hyperbilirubinemia following cardiac surgery is a common phenomenon and is of emerging interest in prognostic factor research. This systematic review and meta-analysis evaluated the association between post-operative hyperbilirubinemia (PH) and mortality and morbidity in cardiac surgery patients. Methods Ovid Medline and Ovid Embase were searched from inception to July 2020 for studies evaluating the prognostic significance of PH following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each study and pooled using random effects inverse variance modelling to assess in-hospital mortality. Standardised mean differences were pooled to assess Intensive Care Unit (ICU) and hospital length of stay (LOS). Qualitative analysis was performed to assess ventilation requirements and long-term mortality. Meta-regression was used to assess inter- and intra-study heterogeneity. Results 3251 studies satisfied the selection criteria, from which 12 studies incorporating 3876 participants were included. PH significantly predicted in-hospital mortality with a pooled OR of 7.29 (95% CI 3.53, 15.09). Multiple pre-defined covariates contributed to the prognostic significance of PH, however only aortic cross-clamp time (p < 0.0001) and number of transfusions (p = 0.0001) were significant effect modifiers. PH significantly predicted both ICU LOS (Mean difference 1.32 [95% CI 0.04–2.6]) and hospital LOS (Mean difference 1.79 [95% CI 0.36–3.21]). Qualitative analysis suggested PH is associated with increased post-operative ventilation requirements and reduced long-term survival rates. Conclusions Hyperbilirubinemia is a cost-effective, widely available prognostic marker of adverse outcomes following cardiac surgery, albeit with residual sources of heterogeneity.https://doi.org/10.1186/s13019-022-01870-2Cardiopulmonary bypassHyperbilirubinemiaJaundiceLength of stayPrognostic biomarkers |
| spellingShingle | Dev Raveendran Jahan C. Penny-Dimri Reny Segal Julian A. Smith Mark Plummer Zhengyang Liu Luke A. Perry The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis Journal of Cardiothoracic Surgery Cardiopulmonary bypass Hyperbilirubinemia Jaundice Length of stay Prognostic biomarkers |
| title | The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis |
| title_full | The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis |
| title_fullStr | The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis |
| title_full_unstemmed | The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis |
| title_short | The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis |
| title_sort | prognostic significance of postoperative hyperbilirubinemia in cardiac surgery systematic review and meta analysis |
| topic | Cardiopulmonary bypass Hyperbilirubinemia Jaundice Length of stay Prognostic biomarkers |
| url | https://doi.org/10.1186/s13019-022-01870-2 |
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