Bilirubin is not an independent predictor of mortality in patients admitted to intensive care with sepsis - A prospective, single-center cohort from South India.

Background: Hyperbilirubinemia is frequently observed in critically ill patients with sepsis and is proposed as a prognostic marker for mortality. However, its independent predictive value, particularly when accounting for established severity indices, remains unclear. Methods: We conducted a prospective cohort study in the intensive care unit (ICU) of a tertiary care center in South India from April 2021 to April 2022. Adults (≥18 years) with sepsis were enrolled, excluding those with preexisting liver disease or alternative causes for hyperbilirubinemia. Serum total bilirubin was measured within 48 h of ICU admission and categorized as normal (≤1.2 mg/dL), mildly elevated (1.21-2 mg/dL), or significantly elevated (>2 mg/dL). Demographic, clinical, and laboratory data were collected. The primary outcome was ICU mortality. Univariate and multivariate logistic regression analyses identified the independent predictors of mortality. Results: Among 110 patients, ICU mortality was 29.1%. Nonsurvivors had significantly higher bilirubin levels (6.2 ± 5.5 mg/dL vs. 1.8 ± 2.3 mg/dL, Conclusion: While hyperbilirubinemia is associated with increased ICU mortality in sepsis, it is not an independent predictor after accounting for disease severity.