간장 ( 肝臟 ) · 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 고 - 고빌리루빈혈증을 보인 간실질 질환 및 담도 폐쇄 환자들의 단기 예후

Serum bilirubin level seldom exceeds 30 mg/dl in the patients with complete extrahepatic biliary obstruction. Therefore, hyper-hyperbilirubinemia which is defined as hyperbilirubinemia above 30 mg/dl of serum bilirubin level is rarely found only in patients with accompanying pigment overload or renal failure in addition to preexisting parenchymal liver disease or biliary obstruction. In this study, shor-term prognosis of 85 patients with hyper-hyperbilirubinemia were evaluated according to the underlying hepatobiliary diseases and precipitating factors. Of 85 patients, 57(67%) were patients with primary parenchymal liver diseases which included 2 cases of acute hepatitis, 4 cases of toxic hepatitis, 5 cases of chronic viral hepatitis, 23 cases of cirrhosis, 22 cases of primary liver cancer, and 1 case of alcoholic liver disease. Seventy six patients (89%) showed clinical deterioration of which 30 terminated to death and 46 were subjected to hopeless discharge. Only 9 patients (11%) were clinically improved during hospitalized period. Most of the survived patients had acute liver diseases, suggesting that preexisting liver disease was important in the determination of short-term prognosis. Analysis of precipitating factors revealed that 96% of patients had either pigment overload or renal failure. All patients except one, who had renal failure with or without pigment overload showed clinical deterioration. Of 21 patients having only pigment overload without renal failure, 8(38%) showed clincial improvement. We concluded that the patients with hyper-hyperbilirubinemia super- imposed on preexisting acute liver disease because of pigment overload had better prognosis than those with hyper-hyperbilirubinemia because of renal failure.