The Clinical Significance of Hyperbilirubinemia Following Trauma

Abstract

In order to assess the clinical significance and prognostic implications, and the influence of some of the major potentially contributory factors to the development of jaundice in trauma patients, we studied records of Trauma Unit patients from 1972–1974. All patients were hypotensive prior to admission to the Unit. The majority (81%) of patients developed hyperbilirubinemia. Maximum bilirubin levels in survivors reached a peak by 5–8 days after injury and returned to normal by 11 days. In patients who died, bilirubin levels were significantly higher than in survivors the fourth day following injury and continued to rise progressively and rapidly until death. In surviving patients there was no correlation between hyperbilirubinemia and number of blood transfusions, sepsis, type of anesthesia, celiotomy, and use of positive end-expiratory pressure, none had cardiac or renal failure, and all were normotensive after arrival in the Unit. The patients who died had longer periods of hypotension and reduced cardiac output, requiring greater resuscitative measures initially. Hepatic morphology showed centrilobular congestion or necrosis with bile stasis.

Conclusions: 1) Hyperbilirubinemia occurs in a majority of severely injured patients. 2) Rapidly and progressively rising bilirubin levels imply a poor prognosis. 3) Hyperbilirubinemia in trauma patients is related to intrahepatic cholestasis. 4) Cholestasis may be a result of prolonged hypotension.