Document Detail

The optimal timing of referral to an intestinal failure program: the relationship between hyperbilirubinemia and mortality.
MedLine Citation:
PMID:  21683197     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Multidisciplinary treatment of pediatric intestinal failure has shown promising results. However, there are limited data as to the optimal time frame for referral of patients to intestinal failure programs. The aim of this study was to explore the relationship of hyperbilirubinemia at referral with patient outcomes in a multidisciplinary program.
METHODS: A retrospective analysis was performed of a prospectively collected database from a multidisciplinary intestinal failure program. Multivariable logistic regression adjusted for age at referral was used to model the association between the conjugated bilirubin at referral and risk of mortality. Median values with range are reported.
RESULTS: Sixty-two patients were referred from 2005 to 2009. Patients presented at age 6.4 months (0.4-261.4 months) and were followed up for 16.8 (0.3-53.0) months. Nine subjects (14.5%) died, and 12 subjects (19.4%) were listed for combined liver-intestine transplant. A 50% mortality was seen in patients referred with a conjugated bilirubin ≥ 7.2 mg/dL (n = 12), whereas mortality at referral bilirubin levels <7.2 mg/dL was 6%. After adjusting for age at referral, patients with a conjugated bilirubin ≥ 7.2 mg/dL at referral were 15.4 times more likely to die than patients who presented with lower bilirubin levels (P = .001; 95% confidence interval, 2.8-83.4).
CONCLUSION: Within a pediatric intestinal failure program, mortality is associated with the degree of hyperbilirubinemia at time of referral. These data strongly suggest that these patients should be referred to a multidisciplinary program early in the evolution of their liver disease.
Patrick J Javid; Frances R Malone; Rachel Bittner; Patrick J Healey; Simon P Horslen
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  46     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-20     Completed Date:  2011-10-31     Revised Date:  2013-03-18    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1052-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Division of Pediatric General Surgery, Seattle Children's Hospital and University of Washington, Seattle, WA 98105, USA.
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MeSH Terms
Academic Medical Centers
Child, Preschool
Cohort Studies
Databases, Factual
Disease Progression
Hospitals, Pediatric
Hyperbilirubinemia / diagnosis*,  mortality*,  surgery
Infant, Newborn
Intestinal Diseases / diagnosis,  mortality*,  surgery*
Kaplan-Meier Estimate
Liver Diseases / diagnosis*,  mortality,  surgery
Logistic Models
Multiple Organ Failure / mortality,  physiopathology,  surgery
Multivariate Analysis
Organ Transplantation / methods,  mortality
Program Evaluation
Referral and Consultation / organization & administration*
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
Survival Rate
United States
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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