Bilirubin In Group Research Articles

Conjugated hyperbilirubinemia is associated with increased morbidity and mortality after neonatal heart surgery.

Cholestasis characterised by conjugated hyperbilirubinemia is a marker of hepatobiliary dysfunction following neonatal cardiac surgery. We aimed to characterise the incidence of conjugated hyperbilirubinemia following neonatal heart surgery and examine the effect of conjugated hyperbilirubinemia on post-operative morbidity and mortality. This was a retrospective study of all neonates who underwent surgery for congenital heart disease (CHD) at our institution between 1/1/2010 and 12/31/2020. Patient- and surgery-specific data were abstracted from local registry data and review of the medical record. Conjugated hyperbilirubinemia was defined as perioperative maximum conjugated bilirubin level > 1 mg/dL. The primary outcome was in-hospital mortality. Survival analysis was conducted using the Kaplan-Meier survival function. Conjugated hyperbilirubinemia occurred in 8.5% of patients during the study period. Neonates with conjugated hyperbilirubinemia were more likely to be of younger gestational age, lower birth weight, and non-Caucasian race (all p < 0.001). Patients with conjugated hyperbilirubinemia were more likely to have chromosomal and non-cardiac anomalies and require ECMO pre-operatively. In-hospital mortality among patients with conjugated hyperbilirubinemia was increased compared to those without (odds ratio 5.4). Post-operative complications including mechanical circulatory support, reoperation, prolonged ventilator dependence, and multi-system organ failure were more common with conjugated hyperbilirubinemia (all p < 0.04). Patients with higher levels of conjugated bilirubin had worst intermediate-term survival, with patients in the highest conjugated bilirubin group (>10 mg/dL) having a 1-year survival of only 6%. Conjugated hyperbilirubinemia is associated with post-operative complications and worse survival following neonatal heart surgery. Cholestasis is more common in patients with chromosomal abnormalities and non-cardiac anomalies, but the underlying mechanisms have not been delineated.

Comparing iodized oil with polyvinyl alcohol for portal vein embolization in promoting liver remnant increase before partial hepatectomy

BackgroundTo compare the efficacy and safety of iodized oil versus polyvinyl alcohol (PVA) particles in portal vein embolization (PVE) before partial hepatectomy. MethodsFrom October 2016 to December 2021, 86 patients who planned to undergo hepatectomy after PVE were enrolled, including 61 patients post-PVE with PVA particles + coils and 25 patients post-PVE with iodized oil + coils. All patients underwent CT examination before and 2–3 weeks after PVE to evaluate the future liver remnant (FLR). The intercohort comparison included the degree of liver volume growth, changes in laboratory data, and adverse events. ResultsThere was no significant difference in the resection rate between the iodized oil group and the PVA particle group (68 % vs. 70 %, p = 0.822). In terms of the degree of hypertrophy (9.52 % ± 13.47 vs. 4.03 % ± 10.55, p = 0.047) and kinetic growth rate (4.07 % ± 5.4 vs. 1.55 % ± 4.63, p = 0.032), the iodized oil group was superior to the PVA group. The PVE operation time in the PVA particle group was shorter than that in the iodized oil group (121. 72 min ± 34.45 vs. 156. 2 min ± 71.58, p = 0.029). There was no significant difference in the degree of hypertrophy between the high bilirubin group and the control group (5.32 % ± 9.21 vs. 6.1 % ± 14.79, p = 0.764). Only 1 patient had a major complication. ConclusionsCompared with PVA particles, iodized oil PVE can significantly increase liver volume and the degree of hypertrophy without any significant difference in safety.

The short and long-term prognostic influences of liver grafts with high bilirubin levels at the time of organ recovery.

Donors with hyperbilirubinemia are often not utilized for liver transplantation (LT) due to concerns about potential liver dysfunction and graft survival. The potential to mitigate organ shortages using such donors remains unclear. This study analyzed adult deceased donor data from the United Network for Organ Sharing database (2002-2022). Hyperbilirubinemia was categorized as high total bilirubin (3.0-5.0mg/dL) and very high bilirubin (≥5.0mg/dL) in brain-dead donors. We assessed the impact of donor hyperbilirubinemia on 3-month and 3-year graft survival, comparing these outcomes to donors after circulatory death (DCD). Of 138622 donors, 3452 (2.5%) had high bilirubin and 1999 (1.4%) had very high bilirubin levels. Utilization rates for normal, high, and very high bilirubin groups were 73.5%, 56.4%, and 29.2%, respectively. No significant differences were found in 3-month and 3-year graft survival between groups. Donors with high bilirubin had superior 3-year graft survival compared to DCD (hazard ratio .83, p=.02). Factors associated with inferior short-term graft survival included recipient medical condition in intensive care unit (ICU) and longer cold ischemic time; factors associated with inferior long-term graft survival included older donor age, recipient medical condition in ICU, older recipient age, and longer cold ischemic time. Donors with ≥10% macrosteatosis in the very high bilirubin group were also associated with worse 3-year graft survival (p=.04). The study suggests that despite many grafts with hyperbilirubinemia being non-utilized, acceptable post-LT outcomes can be achieved using donors with hyperbilirubinemia. Careful selection may increase utilization and expand the donor pool without negatively affecting graft outcome.

Modulation of antioxidant activities, markers of hepatic and renal dysfunctions in alloxan-induced diabetic rats by Combretum dolichopetalum

Diabetes mellitus is a metabolic dysfunction of insulin secretion exhibiting hyperglycemia with abnormalities in protein, fat and carbohydrate metabolism. The present study aimed to investigate the effect of Combretum dolichopetalum (CD) on hepatic parameters, renal indices and antioxidant markers of alloxan-induced diabetic rats. Twenty (20) male rats were used, and they were divided into four groups of five rats each. Group 1- Normal control received distilled water (non-diabetic control); Group 2- Diabetic control received distilled water; Group 3 and Group 4 are Diabetic rats treated with 200 mg/kg and 400 mg/kg of CD extract. There were significant decreases in the final body weights of Group 2 compared with Group 1 and an elevation of the body weights of Groups 3 and 4 compared with Group 2. There were significant increases in the blood glucose concentration of Group 2 compared with Group 1 and a reduction in blood glucose concentration of Groups 3 and 4 compared with Group 2. There were increases in the alanine amino transaminase (ALT), alkaline phosphatase (ALP) activities and serum total and conjugated bilirubin levels of Groups 2 and 3 compared with Group 1, but a reduction in the ALP, ALT activities and total bilirubin in Group 4. There was an elevation in the superoxide dismutase (SOD) the activity of Group 4. There were reductions in catalase activities and no change in the renal indices. The study showed ameliorating potentials on hyperglycemia, hepatoprotective activity and antioxidation effects.

Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction.

For cases of middle and low biliary obstruction with left and right hepatic duct dilatation, the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail. To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction. A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage at the Department of Interventional Radiology, Shaanxi Provincial People's Hospital between March 2016 and March 2022. Based on the puncture path, patients were categorized into two groups: Subxiphoid left hepatic lobe approach group (Group A, 224 cases) and right intercostal, right hepatic lobe approach group (Group B, 200 cases). Liver function improvement, postoperative biliary bleeding incidence, postoperative pain duration, and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the surgery. Patient survival time was recorded during follow-up. All 424 surgeries were successful without adverse events. Group A comprised 224 cases, and Group B had 200 cases. There was no statistically significant difference in basic data between Group A and Group B (P > 0.05). No significant difference in postoperative biliary bleeding incidence was observed between the groups (P > 0.05). The decreased rates for total bilirubin (Group A: 69.23 ± 4.50, Group B: 63.79 ± 5.65), direct bilirubin (Group A: 79.30 ± 11.19, Group B: 63.62 ± 5.64), and alkaline phosphatase (Group A: 60.51 ± 12.23, Group B: 42.68 ± 23.56) in the 1st wk after surgery were significantly faster in Group A than in Group B. The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d (Group A: 40.56 ± 10.32, Group B: 32.22 ± 5.12) and 1 wk (Group A: 73.19 ± 7.05, Group B: 58.81 ± 18.98) after surgery (P < 0.05). Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B (P < 0.05). The patient survival rate was higher in Group A compared to Group B (P < 0.05). In treating jaundice patients with middle and low biliary obstruction, a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.

Effect of Mining Activities on Some Biochemical Parameters of Opanda-Ugya Inhabitants, Toto Local Government of Nigeria

Mining activities are usually associated with environmental pollution and the infiltration of toxic heavy metals into waterways which could be absorbed by plants or used by inhabitants. The aim of this research was to determine the effect of mining activities on some biochemical parameters of Opanda-Ugya inhabitants, Toto Local government of Nigeria. Four hundred and fifty (450) people were interviewed using questionnaires. Eighty (80) of them were carefully grouped into four: Group 1(20 Control), Group 2 (20 inhabitants), Group 3 (20 indirect miners) Group 4 (20 direct miners). The Survey discovered some symptoms that could be associated with heavy metal toxicity among the inhabitants. Biochemical assay of blood samples revealed no significant (P ˃0.05) increase in Serum ALT, AST and Total bilirubin in groups 2, 3 and 4 when compared to control, but a decrease in TP. Serum creatinine levels increased significantly in group 3 when compared to the control. Both creatinine and urea levels elevated significantly in group 2 and group 4 when compared with the control. The result of Oxidative stress markers has indicated a significant increase in the levels of MDA with a concomitant decrease in the levels of GSH in groups 2, 3 and 4 compared to the control. The AChE activity in groups 2, 3 and 4 significantly increased when compared to the control. The levels of CRP increased significantly in groups 3 and 4 when compared to the control. We conclude that the neurological and other disorders observed in some participants could be attributed to chronic inflammation and oxidative stress induced by heavy metal toxicity, thus something should be done by the necessary authority to curtail the long-time effect of Mining activities in this community.

Effect of Serum Bilirubin Levels on Contrast-induced Acute Kidney Injury: A Systematic Evaluation and Meta-analysis.

Contrast-induced acute kidney injury (CI-AKI) is an important complication following the use of iodinated contrast media. Bilirubin has a protective effect but may also aggravate CI-AKI. The purpose of this systematic review was to assess whether bilirubin is a risk factor for CI-AKI. We searched the databases PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid Medline, CNKI (China National Knowledge Infrastructure), VPCS (Vip Paper Check System), Wanfang, and CBM (Chinese BioMedical Literature Database) from the initial date to May 6, 2023. We summarized the results by directly combining the effect-size odds ratio (OR) and 95% confidence interval (CI) and identified sources of heterogeneity through subgroup analysis, sensitivity analysis, and meta-regression analysis. A total of 10 studies (14 data sets) were included: 7 retrospective studies (10 data sets) and 3 prospective studies (4 data sets), involving 12776 participants. The incidence of CI-AKI of 16% (95% CI: 14-19%). Total bilirubin was positively associated with the occurrence of CI-AKI (OR = 1.80; 95% CI: 1.36-2.38). Both low and high bilirubin concentrations were risk factors for CI-AKI. The incidence of CI-AKI was higher in the low bilirubin group than in the high bilirubin group.

Analysis of the mechanism of action of preoperative bilirubin that causes cognitive impairment after liver transplantation: verification of permeability of high-concentration bilirubin

Background: We previously found an association between preoperative bilirubin concentration and cognitive impairment after liver transplantation. In order to study a possible mechanism for bilirubin causing postoperative cognitive dysfunction, we investigated the effect of high concentrations of bilirubin on the blood–brain barrier. Methods: Our model system was 30-week-old transgenic zebrafish fabp10a:cfp-NTR. In preliminary experiments we confirmed systemic absorption after retro-orbital injection using reddish Rhodamine-dextran injected with a Hamilton syringe. For the hyperbilirubinaemia model we used retro-orbital injection of bilirubin, with subsequent measurement of bilirubin concentration in the brain and blood. Food reward learning was conducted for 4 days using the T-maze, and learning cognitive ability videos were filmed without food reward on the 5th day (control group=9/bilirubin group=9). Again using Fabp10a:cfp-NTR zebrafish, methimazole was injected to damage the liver, and after 3 and 7 days, the brain was extracted and stained with Evans blue to check the blood–brain barrier permeability. Results: In the T-maze test, there was no difference between the bilirubin and control groups (P=0.4135). There was no statistically significant difference in the bilirubin level measured in the brain after retro-orbital injection of bilirubin on the 1st, 2nd, and 3rd days between the 10-fold and 50-fold injection groups. However, bilirubin measured in blood decreased over time as blood concentrations increased. As a result of Evans blue staining, there was no difference in colour between the 3rd and 7th day brains compared with the control (Fig. 9). Conclusion: As a result of this study, cognitive dysfunction occurs when liver damage occurs, but this seems to occur even without a change in blood–brain barrier permeability, and bilirubin is not considered to be the sole cause of cognitive dysfunction.

Factors influencing bilirubin elevation and its correlation with UGT1A1 gene polymorphism in the early postoperative period of transjugular intrahepatic portosystemic shunt

Objective: To investigate the factors influencing total bilirubin elevation and its correlation with UGT1A1 gene polymorphism in the early postoperative period of transjugular intrahepatic portosystemic shunt (TIPS). Methods: 104 cases with portal hypertension and esophageal variceal hemorrhage (EVB) treated with elective TIPS treatment were selected as the study subjects and were divided into a bilirubin-elevated group and a normal bilirubin group according to the total bilirubin elevation level during the early postoperative period. Univariate analysis and logistic regression were used to analyze the factors influencing total bilirubin elevation in the early postoperative period. PCR amplification and first-generation sequencing technology were used to detect the polymorphic loci of the UGT1A1 gene promoter TATA box, enhancer c.-3279 T > G, c.211G > A, and c.686C > A. Logistic regression was used to analyze the correlation of four locus alleles and genotypes with elevated total bilirubin in the early postoperative period. Results: Among the 104 cases, 47 patients were in the bilirubin elevated group, including 35 males (74.5%) and 12 females (25.5%), aged (50.72 ± 12.56) years. There were 57 cases in the normal bilirubin group, including 42 males (73.7%) and 15 females (26.3%), aged (51.63 ± 11.10) years. There was no statistically significant difference in age (t = -0.391, P = 0.697) and gender (χ(2) = 0.008, P = 0.928) between the two groups of patients. Univariate analysis revealed that preoperative alanine transaminase (ALT) level (χ(2) = 5.954, P = 0.015), total bilirubin level (χ(2) = 16.638, P < 0.001), MELD score (χ(2) = 10.054, P = 0.018), Child-Pugh score (χ(2) = 6.844, P = 0.022), and postoperative portal vein branch development (χ(2) = 6.738, P = 0.034) were statistically significantly different between the two groups. Logistic regression analysis showed that preoperative ALT level, total bilirubin level, and portal vein branch development after TIPS were correlated with the elevated total bilirubin in the early postoperative period. The polymorphism of the c.211G > A locus of the UGT1A1 gene correlation had elevated total bilirubin in the early postoperative period of TIPS. The risk of elevated total bilirubin was increased in the population carrying allele A (P = 0.001, OR = 4.049) in the early postoperative period. Allelic polymorphisms in the TATA box promoter region and enhancer c.-3279 T > G and c.686C > A had no statistically significant difference between the bilirubin-elevated group and the normal bilirubin group. Conclusion: The preoperative ALT level, total bilirubin level, and portal vein branch development are correlated with the elevated total bilirubin in early postoperative patients. The polymorphisms of the UGT1A1 gene and enhancer c.211G > A are correlated with the occurrence of elevated total bilirubin in the early postoperative period of TIPS. Allele A carrier may have a higher risk of elevated total bilirubin in the early postoperative period.

Evaluation of isolated probiotics on the efficacy of immune system in male and female Wistar rats

Probiotics were isolated from fruits and vegetables. Microscopic, biochemical, and molecular tests were carried out for the characterization of strains of probiotics. To assess the effects of isolated probiotics on immunity, male and female (15 + 15) Wistar rats (n = 3) were randomly distributed into 5 groups: 0-day, negative control, positive control (commercially available Lactobacillus acidophilus-14), laboratory isolated probiotics with accession numbers; Lactobacillus plantarum (MZ707748) and Lactobacillus plantarum (MZ729681), respectively. After hematological investigations, the amounts of IgA and IgG in male and female groups were significantly different (p < 0.05). At the same time, the values of Alanine-transaminase (ALT) and Aspartate-aminotransferase (AST) in both genders were average, and there were no differences (p > 0.05). Male probiotic-treated groups had decreased levels of interleukin-6, bilirubin, and creatinine, but female probiotic-treated groups had a slight rise in bilirubin and creatinine values (p = 0.05). Cellular blood count levels of Hematocrit (HCT) and white blood cells (WBC) in male groups showed considerable differences (p < 0.05), while there were no differences (p > 0.05) in female groups. Levels of Red blood cells (RBC) and mean corpuscular hemoglobin concentration (MCHC) showed distinct changes (p < 0.05) in female groups, while these values were insignificant changes (p > 0.05) among male groups. There were considerable differences between the control and groups that were given probiotics. Histopathological results showed no damage to the liver and thymus. A fecal examination of rats was used to examine the viability and survival of Lactobacilli. Based on blood tests, it was observed that the immune system was boosted and improved in probiotic-treated groups compared to control groups.

Diagnostics Value of Quantitative Magnetic Resonance Imaging (MRI) in Neonatal Acute Bilirubin Encephalopathy.

Background: This study was designed to investigate the diagnostic value of relative signal intensity of globus pallidus on T1-weighted magnetic resonance imaging (MRI) in neonatal acute bilirubin encephalopathy (ABE). Methods: Participants who were recruited in hospital from April 2019 to May 2020 were grouped into mildly increased total serum bilirubin (TSB) group (n = 30), severely increased TSB group (n = 25), or extremely increased TSB group (n = 10) based on the total serum bilirubin level. Bilirubin-induced neurologic dysfunction scale score was used to determine if participants had acute bilirubin encephalopathy. All neonates underwent conventional brain MRI and the relative signal intensity of globus pallidus was measured on T1-weighted images. The diagnostic value of these 3 indices was assessed by receiver operating characteristic curve analysis. Results: There was a significant correlation between relative signal intensity of globus pallidus and total serum bilirubin level in neonates with hyperbilirubinemia (r = 0.551, P < .001). Relative signal intensity of globus pallidus in the extremely increased TSB group was significantly higher than that in severely increased TSB, mildly increased TSB, and healthy control groups. Relative signal intensity of globus pallidus in the acute bilirubin encephalopathy group was significantly higher than that in the non-acute bilirubin encephalopathy group (P < .01). The area under the receiver operating characteristic curve of the relative signal intensity of globus pallidus was 0.765 (P < .01), with sensitivity of 0.655 and specificity of 0.861. The area under the curve of the total serum bilirubin and visual inspection of globus pallidus signal was 0.621 and 0.579, respectively. The area under the curve of relative signal intensity was significantly greater than that of total serum bilirubin and visual inspection (P = .04 for both). Conclusion: Relative signal intensity of globus pallidus, which is an objective assessment, has the potential to be used as a diagnostic tool for acute bilirubin encephalopathy.

EXPLORATION OF CARDIOPROTECTIVE AND ANTIOXIDANT ACTION OF BILIRUBIN IN ISOPRENALINE-INDUCED ISCHEMIA MODEL OF MALE WISTAR ALBINO RATS

Objectives: Ischemic heart disease is one of the leading causes of death worldwide. Bilirubin, an endogenous product of heme catabolism, has remarkable antioxidant properties. This study was planned with an aim to evaluate cardioprotective potential of bilirubin in isoprenaline (ISO)- induced rat myocardial ischemia model. Methods: In this study, a total of 24 adult male Wistar albino rats (200–250 g) were divided into four groups of six rats each. Groups I, III, and IV, respectively, received distilled water (10 mL/kg bw), bilirubin (40 mg/kg bw), and bilirubin (60 mg/kg bw) intraperitoneally (i.p.) for 21 days. Along with that, Groups III and IV received ISO (85 mg/kg bw) subcutaneously (s.c.) on 20th and 21st day. Group II received ISO (85 mg/kg bwi. p.) on 20th and 21st day. After 24 h of ISO administration, rats were sacrificed and biochemical and histopathological parameters were assessed. These parameters were evaluated: Cardiac biomarkers-lactate dehydrogenase (LDH) and creatine kinase (CK-MB) and antioxidant-glutathione reductase (GR). Isolated heart specimens were processed for light microscopy. Results: Administration of bilirubin in Groups III and IV significantly prevented ISO-induced elevation of CK-MB and LDH levels as compared to Group II. Furthermore, there is a significant increase in the levels of GR in Groups III and IV compared to Group II. These changes were significantly higher in Group IV (high dose) compared to Group III (low dose). Light microscopic findings of the myocardium in bilirubin-treated group revealed a well preserved normal morphology of cardiac muscle with minimal evidence of myocardial injury as compared to ISO-treated hearts. Conclusion: Pre-administration with bilirubin is protective against ISO-induced myocardial infarction. This beneficial effect is most likely due to its antioxidant property. This study may trigger interest toward the use of bilirubin as a cardioprotective agent in myocardial infarction.

Correlation of Serum Zinc Level with Hyperbilirubinemia in NeonatesA Case-Control Study

Introduction: Neonatal jaundice is the common cause of hospitalisation in the first month of life. Factors that affect the severity of neonatal jaundice includes maternal, pre-natal, and neonatal factors as well as environmental factors. Zinc (Zn) is one of the factors that affect the severity of neonatal jaundice as it prevents the lipid depolarization of the cell membranes. Hypozincemia may alter the erythrocyte membrane resulting in deficient synthesis of enzymes which play a key role in bilirubin metabolism. Aim: To correlate the serum Zinc level with bilirubin level in neonates with hyperbilirubinemia and also to compare with healthy controls. Materials and Methods: This case-control study was done in Clinical Biochemistry Laboratory of Father Muller Medical College and Hospital, Mangalore, Karnataka, India, from April 2018 to June 2018. Total 60 subjects were included in the study, which was divided into two groups: Neonates with clinically diagnosed hyperbilirubinemia (Group I) and normal healthy neonates as controls (Group II). Serum levels of zinc, total bilirubin, conjugated and unconjugated bilirubin were compared among groups. Correlation among the biochemical parameters was analysed by Karl Pearson’s Correlation Analysis. Results: In present study, 30 subjects were males and 30 females with mean age of 4.90±1.06 days among Group I and 2.50±1.61 days among Group II. This study observed significantly decreased mean levels of serum Zinc (171.24±19.82 μg/dL) in Group I patients when compared to mean levels of serum Zinc (189.23±17.90 μg/ dL) in Group II controls. There was statistically significant positive correlation among serum levels of Zinc and total bilirubin in Group I patients (p&lt;0.05) when compared to Group II. Conclusion: There was statistically significant positive correlation was found among serum levels of Zinc and total bilirubin in cases when compared to healthy controls. Current results showed, zinc may have a protective effect in the incidence of neonatal jaundice.

Association of serum total bilirubin levels with progressive renal decline and end-stage kidney disease: 10-year observational cohort study in Japanese patients with diabetes.

ObjectivePrevious reports have demonstrated the association of serum bilirubin levels with the progression of diabetic nephropathy. The objective of this study is to assess the association of basal bilirubin levels with progressive renal decline (PRD) and end-stage kidney disease (ESKD).MethodsA total of 298 patients with diabetes who visited Kyushu University Hospital (Japan) were recruited and followed up for 10 years. PRD was defined as a negative change in estimated glomerular filtration ratio (eGFR) >3.7%/year, 2.5th percentile. Logistic regression analysis was performed to evaluate the association of total bilirubin levels with PRD and its cut-off point was determined by receiver operating characteristic (ROC) analysis. Kaplan-Meier method and Cox hazard regression analysis were used to evaluate the predictive ability of its cut-off point for ESKD.ResultsLogistic regression model showed that total bilirubin levels were significantly associated with PRD, and ROC analysis showed that its cut-off point was 0.5 mg/dL. Kaplan-Meier method showed that the percent of patients who reached two endpoints, composite endpoint (ESKD or doubling of creatinine level) or 30% eGFR decline, was significantly higher in the low bilirubin group than in the high bilirubin group (18.5% vs 11.0%, P = 0.045; 49.1% vs 42.1%, P = 0.045, respectively, log-rank test). Cox hazard regression models confirmed the independence of the predictive ability of its cut-off point.ConclusionsSerum total bilirubin levels were negatively associated with PRD in diabetic nephropathy and its cut-off point was 0.5 mg/dL. It may be clinically useful for identifying patients at high risk of ESKD.

Cord blood bilirubin level as a predictor of development of pathological hyperbilirubinemia in newborns

Background: Early discharge of healthy term newborns after delivery has become a common practice because of medical and social reasons and economic constraints. Thus, the recognition, follow-up, and early treatment of jaundice has become more difficult as a result of earlier discharge. This study is done to know the cut-off value of cord blood bilirubin and establish correlation between cord blood bilirubin level and development of significant neonatal hyperbilirubinemia without having significant risk factors and its treatment modality and outcome. Methods: This prospective study performed on 150 eligible term newborns born to mothers with ‘A’ Positive, ‘B’ Positive and ‘AB’ Positive blood group. Cord blood was collected from healthy term newborns delivered by caesarean section for total serum bilirubin and blood group. Serum bilirubin estimation was repeated at 72 hrs after birth by peripheral venous blood Results: Subjects were categorized into hyperbilirubinemia and non-hyperbilirubinemia newborns. Babies with serum bilirubin level of ≥17mg/dl after 72 hrs of life were considered for phototherapy and it is taken as significant hyperbilirubinemia in the present study.

Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19.

ObjectivesWe aimed to investigate how changes in direct bilirubin (DBiL) levels in severely/critically ill the coronavirus disease (COVID-19) patients during their first week of hospital admission affect their subsequent prognoses and mortality.MethodsWe retrospectively enrolled 337 severely/critically ill COVID-19 patients with two consecutive blood tests at hospital admission and about 7 days after. Based on the trend of the two consecutive tests, we categorized patients into the normal direct bilirubin (DBiL) group (224), declined DBiL group (44) and elevated DBiL group (79).ResultsThe elevated DBiL group had a significantly larger proportion of critically ill patients (χ2-test, p < 0.001), a higher risk of ICU admission, respiratory failure, and shock at hospital admission (χ2-test, all p < 0.001). During hospitalization, the elevated DBiL group had significantly higher risks of shock, acute respiratory distress syndrome (ARDS), and respiratory failure (χ2-test, all p < 0.001). The same findings were observed for heart damage (χ2-test, p = 0.002) and acute renal injury (χ2-test, p = 0.009). Cox regression analysis showed the risk of mortality in the elevated DBiL group was 2.27 (95% CI: 1.50–3.43, p < 0.001) times higher than that in the normal DBiL group after adjusted age, initial symptom, and laboratory markers. The Receiver Operating Characteristic curve (ROC) analysis demonstrated that the second test of DBiL was consistently a better indicator of the occurrence of complications (except shock) and mortality than the first test in severely/critically ill COVID-19 patients. The area under the ROC curve (AUC) combined with two consecutive DBiL levels for respiratory failure and death was the largest.ConclusionElevated DBiL levels are an independent indicator for complication and mortality in COVID-19 patients. Compared with the DBiL levels at admission, DBiL levels on days 7 days of hospitalization are more advantageous in predicting the prognoses of COVID-19 in severely/critically ill patients.

Hyperbilirubinemia induced oxidative stress resulting in glomerular injury in rats

To observe the effect of hyperbilirubinemia on glomerulus of rats, and to explore its dose-response and mechanism. Twenty-four adult male Sprague-Dawley (SD) rats were divided into four groups according to the random number table method, with 6 rats in each group. Hyperbilirubinemia rat model was reproduced by intraperitoneal injection of bilirubin once every 12 hours for 4 times, at doses of 50, 100, and 200 mg/kg in low, medium, and high dose bilirubin group (LB group, MB group, HB group), respectively. The rats in negative control group (NC group) were given the same solvent without bilirubin powder. Urine was collected 24 hours after administration, and total protein (TP) level was detected. Then the rats were sacrificed, the blood was collected by cardiac puncture, and the total bilirubin (TBil) and direct bilirubin (DBil) levels were measured by automatic biochemical analyzer. The renal tissue was collected and stained with periodic acid-Schiff (PAS) staine, the glomerular morphology was observed under light microscope, and the glomerular injury score was performed. Podocyte morphology was observed by transmission electron microscopy after uranium acetate and lead citrate double staining. The activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were determined by colorimetric method. The expression level of podocyte specific marker Wilms tumor protein-1 (WT-1) was determined by Western blotting. With the increase of bilirubin dose, the contents of 24-hour urine TP, blood TBil, blood DBil and MDA content in kidney tissue were gradually increased, and the SOD activity and WT-1 expression in kidney tissue were gradually decreased. The differences between LB group, MB group, HB group and NC group were statistically significant [24-hour urine TP (mg): 24.85±2.22, 52.57±3.66, 56.84±3.49 vs. 7.50±1.33; blood TBil (μmol/L): 37.75±2.19, 81.37±2.13, 125.13±9.96 vs. 5.53±0.41; blood DBil (μmol/L): 15.50±1.96, 37.88±1.05, 64.53±2.89 vs. 2.38±0.35; kidney MDA (μmol/g): 3.14±0.65, 5.01±0.28, 7.50±1.08 vs. 2.30±0.20; kidney SOD (kU/g): 95.91±10.43, 57.06±15.90, 37.12±11.72 vs. 113.91±12.16; kidney WT-1 protein (WT-1/GAPDH): 0.280±0.006, 0.239±0.006, 0.198±0.001 vs. 0.361±0.005; all P < 0.05]. It was shown under light microscope that uneven thickness of mesangial membrane and basement membrane of the glomerulus, and some of them were accompanied by hyperplasia and widening. The glomerular injury score increased with the increase in bilirubin dose. The differences between LB group, MB group, HB group and NC group were statistically significant (17.50±1.05, 25.00±1.41, 34.00±1.41 vs. 11.67±0.82, all P < 0.05). Transmission electron microscopy showed that with the increase of bilirubin dose, the damage of glomerular podocytes was aggravated. Hyperbilirubinemia induced damage to glomerulus in a dose-dependent manner. In the lethal dose range, the higher the dose, the stronger the damage, which might be related to the oxidative stress promoted by bilirubin and the damage of glomerular podocytes.

Effects of Pasture Type on Metabolism, Liver and Kidney Function, Antioxidant Status, and Plant Secondary Compounds in Plasma of Grazing, Jersey Dairy Cattle During Mid-lactation

Some pasture species are rich in phytochemicals, able to improve milk yield and quality and to reduce the environmental impacts of livestock farming. The phytochemicals interact with the different gene networks within the animal, such as nuclear factor erythroid 2-related factor 2 (NRF2), but their overall impact on animal health remains to be fully understood. The objective of this study was to identify the effects of pasture Legumes and non-leguminous Forbs containing high bioactive compounds on metabolism and activity of the liver, antioxidant response, kidney function, and inflammation of dairy cows using a large array of blood parameters associated with metabolism and the innate immune system. For this purpose, 26 parameters and the concentration of certain bioactive compounds were assessed in blood plasma, collected from the Jersey cows grazing either Grass, Legume, or Forb-based pastures. In addition, serum collected from all the cows was utilized to detect the changes in NRF2 activation in bovine mammary alveolar cells (MACT) and hepatocytes. Compared with Grass, the cows that grazed both Forb and Legume pastures had lower β-hydroxybutyric acid (BHB) and creatinine and larger vitamin E and the ferric reducing ability of the plasma, supporting an improved antioxidative status for these animals. Compared with both Grass and Legume, the cows that graze Forb pasture had lower urea and urea to creatinine ratio, and lower creatinine, indicating a better kidney function. The cows grazing Legume pasture had greater hematocrit, bilirubin, cholesterol, albumin, β-carotene, retinol, and thiol groups but lower ceruloplasmin, paraoxonase, and myeloperoxidase (MPO) than those grazed Grass and Forb pastures, indicating a positive effect of Legume pasture on the liver, oxidative stress, and red blood cells. The plasma of cows in the various pastures was enriched with various isoflavonoids, especially the cows grazed on Forb and Legume pastures, which likely contributed to improving the antioxidative status of those cows. However, this effect was likely not due to the higher activation of NRF2. Overall, these results indicate that Forb and Legume pastures rich in secondary metabolites do not strongly affect the metabolism but can improve the status of the liver and the kidney and improve the efficiency of N utilization and antioxidant response, compared with the Grass pasture.

Risk factors analysis of hyperbilirubinemia after off-pump coronary artery bypass grafting: a retrospective observational study

BackgroundHyperbilirubinemia is a common complication after off-pump coronary artery bypass grafting (OPCAB), but the incidence and the risk factors are unclear. This study aimed to analyze the incidence and risk factors of postoperative hyperbilirubinemia in patients undergoing OPCAB.MethodsFrom December 2016 to March 2019, a total of 416 consecutive patients undergoing OPCAB were enrolled in this single-center retrospective study. Patients were divided into the normal serum total bilirubin group and the hyperbilirubinemia group based on the serum total bilirubin levels. Perioperative variables between the two groups were compared by univariate logistic regression analysis. Then, multivariate binary logistic regression analysis was used to analyze the independent risk factors of developing hyperbilirubinemia in patients underwent OPCAB. P < 0.05 was considered as statistically significant.ResultsThirty two of 416 (7.7%) patients developed postoperative hyperbilirubinemia. Univariate regression analysis showed significant differences in gender (73.96% vs. 93.75%, P = 0.012), preoperative total bilirubin levels (11.92 ± 4.52 vs. 18.28 ± 7.57, P < 0.001), perioperative IABP implantation (22.66% vs. 43.75%, P = 0.008), perioperative blood transfusion (37.50% vs. 56.25%, P = 0.037) between the two groups. Multivariate logistic regression analysis revealed that elevated preoperative serum total bilirubin levels (OR = 1.225, 95% CI 1.145–1.310, P < 0.001), perioperative blood transfusion (OR = 4.488, 95% CI 1.876–10.737, P = 0.001) and perioperative IABP implantation (OR = 4.016, 95% CI 1.709–9.439, P = 0.001) were independent risk factors for hyperbilirubinemia after OPCAB.ConclusionsHyperbilirubinemia is also a common complication after OPCAB. Elevated preoperative serum total bilirubin levels, perioperative blood transfusion, and perioperative IABP implantation were independent risk factors for patients developing hyperbilirubinemia after OPCAB. Further studies need to be conducted to confirm the risk factors of hyperbilirubinemia after OPCAB procedure.

Correlation Between Serum Total Bilirubin Levels and Blood Pressure Variability in Patients With Hypertension

Abstract Background To investigate the effect of serum total bilirubin levels on blood pressure and its variability in patients with hypertension. Methods This study was a retrospective observational study. A total of 189 subjects were recruited from September 2019 to March 2020. All hypertensive patients were scheduled for ambulatory blood pressure and a 24-hour dynamic electrocardiography. Standard deviations of 24-hour systolic and diastolic blood pressure were used as blood pressure variability indicators. A multiple linear regression was used to analyze the relationship between total bilirubin serum levels and blood pressure variability in hypertensive patients. Results All patients were divided into 3 groups according to tertile values of total bilirubin: low (≤12.2 µmol/l, n = 64), moderate (12.3–16.7 µmol/l, n = 64), and high (&amp;gt;16.8 µmol/l, n = 62) total bilirubin groups. Compared with low total bilirubin group, 24-hour mean systolic and diastolic blood pressure, 24-hour systolic blood pressure standard deviation, systolic blood pressure coefficient of variability, and 24-hour systolic blood pressure load were reduced in the moderate and high total bilirubin groups (all P &amp;lt; 0.05). Multiple linear regression analysis showed that female (B = −1.408, P = 0.013), age (B = 0.043, P = 0.035), diabetes (B = 2.624, P &amp;lt; 0.001), and moderate and high bilirubin grouping (B = −1.582, −3.079; both P &amp;lt; 0.05) were influencing factors of 24-hour systolic pressure standard deviation. Serum total bilirubin levels had no effect on the standard deviation of 24-hour diastolic blood pressure(P &amp;gt; 0.05). Conclusions In hypertensive patients, the total bilirubin serum level is an influencing factor for 24-hour systolic blood pressure variability.