Aetiology, management and prognosis of jaundice in adult patients with acute severe intestinal failure

Introduction: Acute severe intestinal failure, otherwise known as Type II intestinal failure (IF), refers to patients with complex metabolic, septic and nutritional problems which develop following major abdominal catastrophes. Jaundice and liver dysfunction is a common complication encountered in such patients. While liver dysfunction is well- recognised in short bowel syndrome, there is very little published information regarding jaundice in Type II IF. Aims: To estimate the prevalence of jaundice in Type II IF, identify predisposing factors and determine the influence of jaundice on outcome. Results: Three hundred and sixty two patients (163 Male) were admitted with Type II IF between 01.04.2000 and 31.03.2009. The median (range) age of the study population was 53 (18-80) years. Of these, 92 (25.4%) patients were jaundiced (serum bilirubin >50nmol/L) at some point during their admission. There was no difference in the demographics or primary diagnosis leading to Type II IF when jaundiced and non- jaundiced patients were compared. Sixty-two patients (67.4%) had microbiologically or radiologically proven infection at the time of jaundice, which appeared to be the most common associated factor. Increased age (p=0.001), longer duration of jaundice (p<0.001) and shorter length of small bowel (p=0.005) were statistically significant indicators of bad prognosis. Fifty of the jaundiced patients (54.3%) died and patients with jaundice had a shorter mean survival than those without (p<0.001). Survival at 1 year was 90% for non- jaundiced patients, but only 62% for jaundiced patients (p<0.001). The 5-year survival rates for non-jaundiced and jaundiced patients were 78% and 45% respectively (p<0.001). Conclusion: Jaundice is common, associated with infection and a significant adverse prognostic factor in patients with acute severe intestinal failure.