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Ann Intensive Care. 2017 Dec;7(1):48. doi: 10.1186/s13613-017-0272-7. Epub 2017 May 2.

Circulating bile acids predict outcome in critically ill patients.

Author information

1
Division of Gastroenterology and Hepatology, Department Internal Medicine 3, Medical University of Vienna, Vienna, Austria.
2
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
3
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium.
4
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
5
5th Medical Department, Kaiser Franz Josef Spital - SMZ Süd, Vienna, Austria.
6
Division of Cardiology, Department Internal Medicine 2, Medical University of Vienna, Vienna, Austria.
7
Division of Gastroenterology and Hepatology, Department Internal Medicine 3, Medical University of Vienna, Vienna, Austria. v.fuhrmann@uke.de.
8
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. v.fuhrmann@uke.de.

Abstract

BACKGROUND:

Jaundice and cholestatic hepatic dysfunction are frequent findings in critically ill patients associated with increased mortality. Cholestasis in critically ill patients is closely associated with stimulation of pro-inflammatory cytokines resulting in impaired bile secretion and subsequent accumulation of bile acids. Aim of this study was to evaluate the clinical role of circulating bile acids in critically ill patients.

METHODS:

Total and individual serum bile acids were assessed via high-performance liquid chromatography in 320 critically ill patients and 19 controls.

RESULTS:

Total serum bile acids were threefold higher in septic than cardiogenic shock patients and sixfold higher than in post-surgical patients or controls (p < 0.001). Elevated bile acid levels correlated with severity of illness, renal dysfunction and inflammation (p < 0.05). Total bile acids predicted 28-day mortality independently of sex, age, serum bilirubin and severity of illness (HR 1.041, 95% CI 1.013-1.071, p < 0.005). Best prediction of mortality of total bile acids was seen in patients suffering from septic shock.

CONCLUSIONS:

Individual and total BAs are elevated by various degrees in different shock conditions. BAs represent an early predictor of short-term survival in a mixed cohort of ICU patients and may serve as marker for early risk stratification in critically ill patients. Future studies should elucidate whether modulation of BA metabolism and signalling influences the clinical course and outcome in critically ill patients.

KEYWORDS:

Bile acids; Cardiogenic shock; Cholestasis; Critically ill patients; ICU; Septic shock

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