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Abnormalities in Bilirubin and Liver Enzyme Levels in Adult Patients With Bacteremia: A Prospective Study

Abnormalities in Bilirubin and Liver Enzyme Levels in Adult Patients With Bacteremia: A... Abstract • Eighty-four patients with bacteremia were surveyed prospectively for biochemical markers of liver damage. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels were elevated in 44 (53%), 39 (47%), 45 (54%), and 5 (6%) of the patients on the first determination (2.0 ± 0.1 days after onset of fever) and in 11 (13%), 17 (20%), 26 (31%), and 1 (1%) on the second determination (5.4 ± 0.2 days after onset of fever), respectively. The elevation rarely exceeded three times the upper limit of normal. One patient had severe jaundice. An abnormality of at least one of these values was found in 55 patients (65%). There were no differences in site of infection, bacteria isolated, and outcome between patients with and without biochemical abnormalities. We conclude that in adult patients with bacteremia, elevation of liver enzymes and bilirubin is common, usually mild, of short duration, and of no prognostic significance. (Arch Intern Med. 1989;149:2246-2248) References 1. Hamilton JR, Sass-Kortsak A. Jaundice associated with severe bacterial infection in young infants . J Pediatr . 1963;63:121-132.Crossref 2. Rooney JC, Hill DJ, Danks DM. Jaundice associated with bacterial infection in the newborn . AJDC . 1971;122:39-41. 3. Vermillion SE, Gregg JA, Baggenstoss AH, Bartholomew LG. Jaundice associated with bacteremia . Arch Intern Med . 1969;124:611-618.Crossref 4. Miller DJ, Keeton GR, Webber BL, Saunders SJ. Jaundice in severe bacterial infection . Gastroenterology . 1976;71:94-97. 5. Franson TR, Hierholzer WJ, LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia . Rev Infect Dis . 1985; 7:1-9.Crossref 6. Smith-Erichsen N. Renal and liver function tests in surgical septicemia . Acta Anaesthesiol Scand . 1987;31:208-213.Crossref 7. Zimmerman HJ, Fang M, Utili R, Seeff LB, Hoofnagle J, Jaundice due to bacterial infection . Gastroenterology . 1979;77:362-374. 8. Tugswell P, Williams O. Jaundice associated with lobar pneumonia . Q J Med . 1977;66:97-118. 9. Ramachandran S, Godfrey JJ, Perera MVF: typhoid hepatitis . JAMA . 1974;230:236-240.Crossref 10. Utili R, Abernathy CO, Zimmerman HJ. Cholestasic effects of Escherichia coli endotoxin on the isolated perfused rat liver . Gastroenterology . 1976;70:248-253. 11. Utili R, Abernathy CO, Zimmerman HJ. Inhibition of Na+, K+ adenosinetriphosphatase by endotoxin: a possible mechanism for endotoxin-induced cholestasis . J Infect Dis . 1977;136:583-587.Crossref 12. Gimson AES. Hepatic dysfunction during bacterial sepsis . Intensive Care Med . 1987;13:162-166.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Abnormalities in Bilirubin and Liver Enzyme Levels in Adult Patients With Bacteremia: A Prospective Study

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1989.00390100070017
Publisher site
See Article on Publisher Site

Abstract

Abstract • Eighty-four patients with bacteremia were surveyed prospectively for biochemical markers of liver damage. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels were elevated in 44 (53%), 39 (47%), 45 (54%), and 5 (6%) of the patients on the first determination (2.0 ± 0.1 days after onset of fever) and in 11 (13%), 17 (20%), 26 (31%), and 1 (1%) on the second determination (5.4 ± 0.2 days after onset of fever), respectively. The elevation rarely exceeded three times the upper limit of normal. One patient had severe jaundice. An abnormality of at least one of these values was found in 55 patients (65%). There were no differences in site of infection, bacteria isolated, and outcome between patients with and without biochemical abnormalities. We conclude that in adult patients with bacteremia, elevation of liver enzymes and bilirubin is common, usually mild, of short duration, and of no prognostic significance. (Arch Intern Med. 1989;149:2246-2248) References 1. Hamilton JR, Sass-Kortsak A. Jaundice associated with severe bacterial infection in young infants . J Pediatr . 1963;63:121-132.Crossref 2. Rooney JC, Hill DJ, Danks DM. Jaundice associated with bacterial infection in the newborn . AJDC . 1971;122:39-41. 3. Vermillion SE, Gregg JA, Baggenstoss AH, Bartholomew LG. Jaundice associated with bacteremia . Arch Intern Med . 1969;124:611-618.Crossref 4. Miller DJ, Keeton GR, Webber BL, Saunders SJ. Jaundice in severe bacterial infection . Gastroenterology . 1976;71:94-97. 5. Franson TR, Hierholzer WJ, LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia . Rev Infect Dis . 1985; 7:1-9.Crossref 6. Smith-Erichsen N. Renal and liver function tests in surgical septicemia . Acta Anaesthesiol Scand . 1987;31:208-213.Crossref 7. Zimmerman HJ, Fang M, Utili R, Seeff LB, Hoofnagle J, Jaundice due to bacterial infection . Gastroenterology . 1979;77:362-374. 8. Tugswell P, Williams O. Jaundice associated with lobar pneumonia . Q J Med . 1977;66:97-118. 9. Ramachandran S, Godfrey JJ, Perera MVF: typhoid hepatitis . JAMA . 1974;230:236-240.Crossref 10. Utili R, Abernathy CO, Zimmerman HJ. Cholestasic effects of Escherichia coli endotoxin on the isolated perfused rat liver . Gastroenterology . 1976;70:248-253. 11. Utili R, Abernathy CO, Zimmerman HJ. Inhibition of Na+, K+ adenosinetriphosphatase by endotoxin: a possible mechanism for endotoxin-induced cholestasis . J Infect Dis . 1977;136:583-587.Crossref 12. Gimson AES. Hepatic dysfunction during bacterial sepsis . Intensive Care Med . 1987;13:162-166.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1989

References