Reestimation of the bilirubin decrease rate ?b? (b value) in patients with obstructive jaundice

Abstract

In 1978 and 1979 we reported a formula for serum bilirubin decrease after biliary drainage in 62 patients with obstructive jaundice1,2 The bilirubin decrease rate “b” was determined as Y=aebx, where the b value severed as a marker of the severity of the disease and the prognosis of these patients. In the present study, we examined 576 patients with obstructive jaundice, including 33 patients with acute renal failure due to obstructive cholangitis, using this b value. The patients with cholangitis showed a slow reduction pattern, and belonged to the worse b value groups. However, many patients with acute renal failure whose underlying disorder was incarcerated gallstone in the papilla were in the group with a good bilirubin decrease and had no ductal cell degeneration in the liver; then had a good prognosis after satisfactory biliary drainage and organ support. These findings suggest that ductal cell degeneration in the liver is closely related to a better b value. Therefore, a better b value can be expected after biliary drainage in patients with acute obstructive jaundice due to incarcerated stone in the common bile duct, even if there is associated renal failure, since ductal cell degeneration in the liver is not usually noted in these patients.