Hyperbilirubinemia and Sepsis

Q: Hyperbilirubinemia ________________ intestinal wall permeability? (select one)

A) decreases

B) increases

Answer: B

It is important to understand that hyperbilirubinemia can have many indirect consequences. It alters mucosal immunity, increases permeability, and may promote bacterial sepsis, particularly gram-negative bacteremia from the gut flora. 

Sepsis and hyperbilirubinemia can have synergistic negative effects on each other. Sepsis usually causes a low perfusion state, which leads to cholestasis. Other factors during sepsis, such as hypotension, drugs, and bacterial endotoxins, contribute to this pathology. All these factors give rise to hyperbilirubinemia, which sets a negative cycle, as described in the first paragraph above.

Similar pathology occurs with hyperbilirubinemia, as in heart failure and hypoxemia (ARDS).

#hepatology

References:

1. Fuchs M, Sanyal AJ. Sepsis and cholestasis. Clin Liver Dis 2008; 12:151.

2. Patel JJ, Taneja A, Niccum D, Kumar G, Jacobs E, Nanchal R. The association of serum bilirubin levels on the outcomes of severe sepsis. J Intensive Care Med. 2015 Jan;30(1):23-9. doi: 10.1177/0885066613488739. Epub 2013 May 22. PMID: 23753252.

3. Ghenu MI, Dragoş D, Manea MM, Ionescu D, Negreanu L. Pathophysiology of sepsis-induced cholestasis: A review. JGH Open. 2022 May 25;6(6):378-387. doi: 10.1002/jgh3.12771. PMID: 35774351; PMCID: PMC9218521.