How does bilirubin level affect sepsis?

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Posted on Thu, 6 Nov 2014 in Medicines and Side Effects
Question: (1) Why are doctors more concerned if sepsis is accompanied by a sudden onset of hyperbilirubinemia (e.g. total biliribin at 76 umol/L) than if there is no hyperbilirubinemia with the sepsis? (2) Would there be such a concern, for instance, if the sudden onset of hyperbilirubinemia is accompanied by pneumonia? (3) If a sudden increase of total bilirubin to 76 umol/L is accompanied by sepsis then what, if anything, could be done about it? (4) Is it of any importance that the albumin is 35 g/L; protein is 69 g/L; ALP is 133 U/L; Gamma GT is 76 U/L; ALT is 21 U/L and AST is 29 U/L? (5) The person does have a gallstone. I appreciate that this may be a complex matter and that you might not be able to have all the information that you need to give a definitive opinion.
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Answered by Dr. Panagiotis Zografakis 36 minutes later
Brief Answer:
Please read on...

Detailed Answer:
Hello,

it would -probably- be better if you'd presented the case in detail and asked the questions then. I'll try to answer them, although as you've pointed out more data would have helped. I'll present a general approach for an otherwise healthy individual.
(1) bilirubin is a measure of liver function. 76 (or 4.6mg/dL) is not that high and can be attributed to benign causes like the XXXXXXX syndrome which normally causes that high total bilirubin under stressful conditions (sepsis is a usual cause). Higher elevations should normally alert your doctors. Possible causes (in sepsis) include hemolysis (destruction of red blood cells) and liver dysfunction (which is usually accompanied by other laboratory findings as well).
(2) for that level of bilirubinemia there is no difference whether it's pneumonia or another cause.
(3) the doctor focuses on the sepsis cause. He can't do anything more than fighting the sepsis unless liver failure is considered imminent.
(4) yes it is. A normal liver chemistry reduces the probablity of liver damage.
(5) the gallstone can cause bilirubin elevations but we'd also expect some liver chemistry findings and symptoms, not to mention ultrasound evidence which is the most reliable of the above.
I hope I've given you the answers you were after.
If you need further clarifications, please provide more details.
I'll be happy to help.

Kind Regards!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Panagiotis Zografakis 10 hours later
Thank you Dr Zografakis for your help especially since I have made it more difficult for you by not providing more data. I do have two final general questions that I would like to ask you. If a patient has an onset of sepsis AND a sudden onset of hyperbilirubinemia at the same time would this be GENERALLY considered to make it less likely for an elderly patient to survive? Why (although I appreciate that the limited information might not make it possible to answer the second part of the question)? The patient also has chronic heart failure, hypotension & renal impairment.
doctor
Answered by Dr. Panagiotis Zografakis 7 hours later
Brief Answer:
It depends

Detailed Answer:
Hello,

I've kind of answered the first question, albeit indirectly.
It depends on the cause. If hyperbilirubinemia is the result of liver failure then this is a very serious condition, that may lead to death.
When sepsis is diagnosed, the doctor stays alert for organ failure. Any organ can suffer serious damage when sepsis is not under control. Bilirubin levels elevation is an indicator for the liver but this is not a very specific one.
For example, if a patient suffers from acute cholangitis (I'm not referring to your case right now, it's just an example), then the bilirubin would be sky high (much higher than 4-5mg/dL, could be 15-20) but the liver will still be able to recover if appropriate and prompt medical treatment is provided.
On the other hand, if a patient has sepsis from another cause and bilirubin suddenly rises along with patient status deterioration then this could be taken much more seriously as a liver damage indicator.
Other potential clues for liver damage include the prothrombin time (fairly fast indicator), albumin (slow), liver enzymes (transaminases, alkaline phosphatase) and ammonia levels (usually used to support the diagnosis of hepatic encephalopathy). The liver enzymes are more reliable to detect liver damage but not so reliable to diagnose liver failure.
The reason that survival is reduced is self-explicit. Organ failure is a major incident and has to be aggressively and promptly treated (if it is possible) whether it's the liver or the kidneys or any organ.
Since you're asking only for bits of information, I'm not sure if this is the answer you were after. I really hope you got the information you wanted!
If you need further explanations, please ask again!

Kind Regards!
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3680 Questions

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