Kalp Cerrahisi Sonrasý Görülen Sarýlýk ve Sonuçlarý

Amaç: Kalp cerrahisi sonrasý erken dönemde hiperbilirubinemiye baðlý sarýlýk hastalarýn %10 ila %23’ünde geliþir. Çalýþmamýzýn amacý, sarýlýða neden olan hiperbilirubineminin risk faktörlerini ve klinik sonuçlarýný incelemektir.
Yöntem: Bu retrospektif çalýþmada, Þubat 2015-Mart 2021 tarihleri arasýnda kalp cerrahisi geçiren hastalar deðerlendirildi. Acil veya elek-tif cerrahi uygulanýp postoperatif dönemde sarýlýk geliþen ve total bilirubin konsantrasyonu >3 mg/dL olan hastalar çalýþmamýza dahil edildi. Temel demografik, ekokardiyografik, laboratuvar, ameliyat ve ameliyat sonrasý veriler kapsamlý bir þekilde toplandý. ROC analiziyle postoperatif total bilirubin cut-off deðeri hastane mortalitesine göre hesaplandý.
Bulgular: Toplam bilirubin konsantrasyonu 27 hastada >3 mg/dL olarak bulundu. Hastalarýn ortalama total bilirubin deðeri 9,56±6,427 mg/L, medyan toplam bilirubin deðeri 9,02 mg/L olarak bulundu. Hastalar maksimum bilirubin konsantrasyonuna ameliyat sonrasý 9,52±8,007 günde ulaþtý. Hastanede 17 (%63,0) hastada mortalite görüldü. Hastane içi mortaliteyi öngörmek amacýyla hesaplanan postoperatif total bilirubinin cut-off deðeri 9,24 mg/L olarak bulundu (duyarlýlýk= %70,6, özgül-lük= %90, olabilirlik oraný=7,05).
Sonuç: Kalp cerrahisi sonrasý dönemde hiperbilirubinemi geliþen hastalar düþük kalp debisi sendromu, sepsis veya akut karaciðer yetmezliði açýsýndan dikkatle izlenmelidir. Kalp debisi ve oksijen sunumu yeterli olduðunda düþük seviyeli hiperbilirubinemi çoðunlukla geri dönüþümlüdür. Ancak þiddetli persistan hiperbilirubinemi erkenden fark edilmesi ve önlem alýnmasý gereken bir durumdur.

Jaundice and Its Results After Cardiac Surgery

Objectives: Jaundice due to hyperbilirubinemia develops in 10–23% of patients in the early period after cardiac surgery. The aim of our study is to examine the risk factors and clinical consequences of hyperbilirubinemia causing jaundice.
Methods: In this retrospective study, patients who underwent cardiac surgery in our clinic between February 2015 and March 2021 were evaluated. Patients who underwent routine or emergency surgery, who developed post-operative jaundice, and whose total bilirubin concentration was >3 mg/dL were included in our study. The baseline demo-graphic data, echocardiography data, laboratory data, operative data, and post-operative status were comprehensively collected. The cutoff value of post-operative total bilirubin was calculated according to hospital mortality in receiver operating characteristic analysis.
Results: Total bilirubin concentration was found to be >3 mg/dL in 27 patients. Mean total bilirubin (mg/L) was 9.56±6.427 and median total bilirubin score was 9.02 and the maximum bilirubin concentration was reached at 9.52±8.007 post-operative days. In-hospital mortality occurred in 17 (63.0%) patients. The cutoff for post-operative total bilirubin value was calculated as 9.24 by predicting in-hospital mortality (Sensitivity=70.6%, specificity=90%, and likelihood ratio: 7.05).
Conclusion: Patients who develop hyperbilirubinemia in the post-operative period of cardiac surgery should be carefully observed for low cardiac output syndrome, sepsis, or acute liver failure. Low-level hyperbilirubinemia is mostly reversible when cardiac output and oxygen delivery are adequate. However, severe persistent hyperbilirubinemia is a condition that needs to be recognized early and precautions should be taken.