PT - JOURNAL ARTICLE AU - Karampela, Irene AU - Chrysanthopoulou, Evangelia AU - Skyllas, George AU - Simitsis, Panagiotis AU - Christodoulatos, Gerasimos Socrates AU - Kandri, Evangelia AU - Antonakos, George AU - Armaganidis, Apostolos AU - Dalamaga, Maria TI - Serum bilirubin/fetuin-A ratio in critically ill septic patients: a prospective study AID - 10.1183/13993003.congress-2020.2750 DP - 2020 Sep 07 TA - European Respiratory Journal PG - 2750 VI - 56 IP - suppl 64 4099 - http://erj.ersjournals.com/content/56/suppl_64/2750.short 4100 - http://erj.ersjournals.com/content/56/suppl_64/2750.full SO - Eur Respir J2020 Sep 07; 56 AB - Aims and Objectives: Sepsis constitutes an acute inflammatory response to infection affecting liver function. Increased serum bilirubin as well as decreased fetuin-A, a major hepatokine, have been shown in critically ill patients with sepsis. We aim to explore the association of serum bilirubin/fetuin-A (B/F) ratio early in sepsis with severity and outcome.Methods: In a prospective study, serum total bilirubin and fetuin-A were determined in 90 critically ill patients (52 males, age 65±15 years, APACHE II 24 ±7, SOFA 10±3) at sepsis onset and one week after. B/F ratio was calculated using the formula 10.000 x Bilirubin (mg/dL) / Fetuin-A (μg/mL). Mortality rate at 28 days after enrollment was the primary outcome.Results: Twenty eight patients (31%) died within 28 days. Bilirubin and fetuin-A increased one week after sepsis onset compared to baseline (1.16±2.3 vs 1.38±2.84mg/dL, p=0.03 and 306±107 vs 372±147μg/mL, p<0.001, respectively) while B/F ratio did not change significantly (42.5±82.3 vs 45.5±99.7, p=0.47). B/F ratio was significantly higher and fetuin-A lower in patients presenting with septic shock (N=38) compared to sepsis (N=52) and in nonsurvivors (N=28) compared to survivors (N=62) both at enrollment and one week after, while baseline bilirubin did not significantly differ. Baseline B/F ratio was significantly associated with APACHE and SOFA. ROC curve analysis showed that baseline B/F ratio outperformed bilirubin as predictor of 28-day mortality (AUC: 0.78, 95%CI 0.69-0.88, p<0.001 and 0.69, 95%CI 0.57-0.8, p=0.003, respectively).Conclusions: B/F ratio at sepsis onset is associated with severity and outcome and may be a useful prognostic biomarker in critically ill septic patients.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 2750.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).