Serum Bilirubin Concentration Research Articles

The U-shaped association between serum direct bilirubin and incident mild cognitive impairment in hemodialysis patients: a multicenter study

BackgroundPrevious studies have suggested an association between low serum bilirubin concentrations and increased risk of cognitive impairment. This study aimed to explore the association and dose-response relationship between serum direct bilirubin (DBIL) concentrations and mild cognitive impairment (MCI) among hemodialysis patients.MethodsThis is a multicenter cross-sectional study with patients undergoing hemodialysis from 22 dialysis centers in Guizhou Province, China. The outcome was mild cognitive impairment (MCI), measured with a Mini-Mental State Examination. The association and dose-response relationship between serum DBIL and MCI incidence were examined using multivariate logistic regression analysis, restricted cubic spline, and subgroup analysis to explore the association of serum DBIL concentrations with MCI.ResultsOf the 4223 enrolled patients (mean age 55.2 ± 15.3 years, 60.4% males), 1187 (28.1%) had MCI. Serum DBIL of 0.10-1.67umol/L [multivariable-adjusted odds ratios (OR) 1.32, 95% confidence interval (CI): 1.08–1.60, P = 0.005], 2.31-3.20umol/L (OR = 1.22, 95%CI: 1.00-1.49, P = 0.047), and > 3.21umol/L (OR = 1.32, 95%CI: 1.08–1.61, P = 0.006) had increased risk of MCI compared with 1.68-2.30umol/L. The dose-response analysis between serum DBIL and MCI showed a U-shaped relationship (P for non-linearity = 0.009), and the serum DBIL concentrations with the lowest risk of MCI was 2.01umol/L. As the serum DBIL concentrations were lower than the reference, the risk of MCI decreased by 49% per standard deviation (SD) increase in serum DBIL (OR = 0.51, 95%CI: 0.29–0.89, P < 0.001); when the concentration exceeds 2.01umol/L, a rise per SD increased the risk of MCI by 9% (OR = 1.09, 95%CI:1.01–1.17, P < 0.001).ConclusionOur findings suggest a U-shaped association between serum DBIL and MCI among hemodialysis patients.

Growth Performance, Dietary Energetics, Blood Metabolites, Carcass Traits, Meat Quality, and Gene Expression of Lambs Supplemented with a Polyherbal Phytogenic Additive

This study aimed to evaluate the effects of supplementation with a polyherbal phytogenic additive (PPA) on the productive performance, dietary energetics, blood metabolites, carcass traits, meat quality, and gene expression of finishing lambs. Thirty-six male Pelibuey lambs (23.61 ± 0.57 kg body weight (BW)) were housed in individual pens and assigned to four treatments (n = 9) with different doses of PPA: 0 (CON), 2.5 (PPAL), 5 (PPAM), and 7.5 (PPAH) g of PPA/kg of DM for 56 days. Average daily gain, dry matter intake, and observed dietary net energy for maintenance and weight gain increased linearly (p &lt; 0.05) in lambs supplemented with PPAH. A linear reduction (p = 0.02) in FCR was detected in lambs fed PPAM and PPAH. The PPAH supplementation linearly increased (p &lt; 0.001) Longissimus dorsi muscle area, but other carcass traits were not affected (p &gt; 0.05) by PPA doses. The physicochemical characteristics of the meat and the hematological parameters of the lambs were not affected (p &gt; 0.05) by the PPA doses. The glucose, uric acid, creatinine, and bilirubin serum concentrations decreased linearly (p &lt; 0.05) in lambs supplemented with PPAM and PPAH. Gene ontology analyses showed that nine biological processes were modified (p &lt; 0.05), including DNA replication, drug metabolism–cytochrome P450, oxidative phosphorylation, and chemical carcinogenesis–reactive oxygen species. In conclusion, high doses (7.5 g/kg DM) of PPA can improve growth performance and dietary energy utilization efficiency in finishing lambs. Likewise, gene expression analysis indicates that supplementation with high doses of PPA could improve energy production and antioxidant status in finishing lambs.

Short-term reduction in feed intake by dairy cows in the postpartum period leads to subclinical ketosis development

Subclinical ketosis is widespread in highly productive dairy cows after calving and often remains undiagnosed, leading to reduced productivity. Physiologically controlled feeding in the first weeks after calving and during the intensive lactation period can reduce the incidence of ketosis. The study aimed to determine how a short-term reduction of feed after calving affects the formation of ketone bodies in blood, urine and milk of dairy cows. The group of ten Ukrainian black-spotted dairy breed cows after calving aged from 4 to 6 years was involved in the experiment lasted for 72 h. In 24 h the amount of compound feed, haylage, and silage received by cows was gradually reduced until complete exclusion in the diet. Blood, urine, and milk samples were collected three times a day. The content of ketone bodies, β-hydroxybutyrate and glucose was estimated with the corresponding sets of indicator strips. The content of total bilirubin, cholesterol, albumin and enzymes activity in the blood serum were determined on biochemical analyzer. It was found that in 24 h after the beginning of feed reduction the level of blood glucose decreased, persistent hypoglycemia within 48 and 72 h was developed, the concentration of β-hydroxybutyrate in blood and milk and of ketone bodies in urine was elevated. The increase in total bilirubin concentration and liver enzymes activity in the blood serum with a simultaneous decrease in albumin level and delayed sodium propionate conversion into glucose were observed. Thus, short-term reduction in feed intake by dairy cows after calving causes ketosis development and violation of liver functions. Keywords: dairy сows, feeding level, glucose, ketosis, liver damage, β-hydroxybutyrate

Iodine Bioavailability and Biochemical Effects of Brassica oleracea var. sabellica L. Biofortified with 8-Hydroxy-7-iodo-5-quinolinesulfonic Acid in Wistar Rats

Background: Iodine is one of the essential trace elements for human life. The main objective of the biofortification of plants with iodine is to obtain food with a higher content of this element compared to conventional food. Biofortification of plants with iodine can increase the intake of this trace element by different populations. In addition, it may reduce the risk of iodine deficiency diseases. Objectives: The aim of the study was to investigate the effect of kale biofortified with 8-hydroxy-7-iodo-5-quinolinesulfonic acid (8-OH-7-I-5QSA) on iodine bioavailability and biochemical effects in Wistar rats. Methods: Kale biofortified with (8-OH-7-I-5QSA) was tested for iodine levels in urine, feces, and selected tissues using the ICP-MS/MS technique. The feeding experiment was designed to investigate potential changes in selected thyroid-regulated biochemical parameters in blood serum of Wistar rats. Results: The dietary intake of Wistar rats fed kale biofortified with (8-OH-7-I-5QSA) from both the “Oldenbor F1” and “Redbor F1” cultivars for 8 weeks resulted in significantly (p ≤ 0.05) higher iodine concentrations in the urine and kidneys of rats, which proves iodine bioavailability. Rats’ diets with “Oldenbor F1” and “Redbor F1” kale non- and -biofortified with 8-OH-7-I-5QSA had a significantly (p ≤ 0.05) lower or a tendency for lower concentration of TSH, triglyceride, total and direct bilirubin, TBARs, uric acid, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations in serum. Dietary intake of “Oldenbor F1” and “Redbor F1” kale biofortified with 8-OH-7-I-5QSA significantly (p ≤ 0.05) increased the total antioxidant status (TAS). Conclusions: Our study confirms that kale biofortified with iodine in organic form iodoquinoline 8-OH-7-I-5QSA is bioavailable and well absorbed by the Wistar rat and has a positive effect on selected biochemical parameters. The results obtained in this study may be highly predictive for further studies in humans.

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border

BackgroundNeonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.MethodsA study was carried out at Shoklo Malaria Research Unit (SMRU)...

Unconjugated bilirubin promotes uric acid restoration by activating hepatic AMPK pathway

Hyperuricemia and its development to gout have reached epidemic proportions. Systemic hyperuricemia is facilitated by elevated activity of xanthine oxidase (XO), the sole source of uric acid in mammals. Here, we aim to investigate the role of bilirubin in maintaining circulating uric acid homeostasis. We observed serum bilirubin concentrations were inversely correlated with uric acid levels in humans with new-onset hyperuricemia and advanced gout in a clinical cohort consisting of 891 participants. We confirmed that bilirubin biosynthesis impairment recapitulated traits of hyperuricemia symptoms, exemplified by raised circulating uric acid levels and accumulated hepatic XO, and exacerbated mouse hyperuricemia development. Bilirubin administration significantly decreased circulating uric acid levels in hyperuricemia-inducing (HUA) mice receiving potassium oxonate (a uricase inhibitor) or fed with a high fructose diet. Finally, we proved that bilirubin ameliorated mouse hyperuricemia by increasing hepatic autophagy, restoring antioxidant defense and normalizing mitochondrial function in a manner dependent on AMPK pathway. Hepatocyte-specific AMPKα knockdown via adeno-associated virus (AAV) 8-TBG-mediated gene delivery compromised the efficacy of bilirubin in HUA mice. Our study demonstrates the deficiency of bilirubin in hyperuricemia progression, and the protective effects exerted by bilirubin against mouse hyperuricemia development, which may potentiate clinical management of hyperuricemia.

Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation: Technical Report.

To summarize the principles and application of phototherapy consistent with the current 2022 American Academy of Pediatrics "Clinical Practice Guideline Revision for the Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation." Relevant literature was reviewed regarding phototherapy devices in the United States, specifically those that incorporate blue to blue-green light-emitting diode, fluorescent, halogen, or fiberoptic light sources, and their currently marketed indications. The efficacy of phototherapy devices varies widely because of nonstandardized use of light sources and configurations and irradiance meters. In summary, the most effective and safest devices have the following characteristics: (1) incorporation of narrow band blue-to-green light-emitting diode lamps (∼460-490 nm wavelength range; 478 nm optimal) that would best overlap the bilirubin absorption spectrum; (2) emission of irradiance of at least 30 µW/cm2/nm (in term infants); and (3) illumination of the exposed maximal body surface area of an infant (35% to 80%). Furthermore, accurate irradiance measurements should be performed using the appropriate irradiance meter calibrated for the wavelength range delivered by the phototherapy device. With proper administration of effective phototherapy to an infant without concurrent hemolysis, total serum or plasma bilirubin concentrations will decrease within the first 4 to 6 hours of initiation safely and effectively.

Hepatosis in broiler chickens: The role and efficacy of therapeutic and prophylactic agents containing hepatoprotectors

The preservation of poultry stock can be improved by incorporating therapeutic and preventive agents, including hepatoprotectors, into the diet. This study aimed to evaluate the effect of an experimental drug containing hepatoprotectors on the health of broiler chickens. The research sought to identify the potential of the preparation to enhance liver function and overall poultry stock survival. The study was conducted from 2023 to 2024 at Odesa State Agrarian University. Investigations were carried out to assess the effects of the experimental preparation in the following doses: 1.0 g/kg body weight (therapeutic dose), 2.0 g/kg body weight (double therapeutic dose), and 5.0 g/kg body weight (fivefold therapeutic dose) over 30 days. The experiment was conducted on 500 Cobb 500 broiler chickens aged 1 to 40 days. Additionally, biochemical blood parameters were measured and analysed using a Polish biochemical selective automatic analyser, the Hitachi 902. Studies have established that the optimal dose of the experimental drug for hepatosis in broiler chickens is 1.0 g/kg body weight. After administration of the drug, the serum bilirubin content decreased by 27.3%, lactate dehydrogenase activity decreased by 17.1%, aspartate aminotransferase activity decreased by 16.4%, alanine aminotransferase activity decreased by 19.3%, and vitamin A content increased by 25.6%, while the phagocytic activity of pseudoeosinophils increased by 23.1%. The results of the studies have proven that the experimental drug normalises liver function, positively affects the biochemical composition of blood, promotes growth, provides protection and natural resistance of the broiler organism, and even improves the quality of poultry products. Based on the above, it is necessary to improve methods for early diagnosis of liver function disorders in poultry and apply effective methods for correcting metabolic processes

Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization.

Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and therole of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter.

Temporal alteration of serum bilirubin levels and its renoprotective effects in diabetic kidney disease: exploring the hormonal mechanisms.

This current study represents a novel endeavor to scrutinize the correlation between the temporal alteration in serum total bilirubin (TBIL) concentrations and the rate of estimated glomerular filtration rate (eGFR). Additionally, this study aims to probe the plausible molecular mechanism underpinning the renoprotective effects of bilirubin concerning its hormonal characteristics. In this study, a cohort of 103 patients diagnosed with DKD and receiving medical care at Dongzhimen Hospital were recruited and monitored over a period of 2-7 years. The progression of DKD was ascertained using a threshold of eGFR decline > -5.48%/year. To assess the relationship between the annual change in serum TBIL levels (%/year) and the slope of eGFR, multivariate binary logistic regression analysis was employed. Furthermore, the ROC curve analysis was employed to determine the cut-off value for TBIL levels (%/year). The use of multivariate binary logistic regression models revealed that serum TBIL levels (%/year) exhibited a significant correlation with the slope of eGFR. Moreover, the ROC curve analysis indicated a cut-off value of -6.729%/year for TBIL levels (%/year) with a sensitivity of 0.75 and specificity of 0.603, in diagnosing eGFR decline >-5.48%/year. The findings of this study suggest that the sustained elevation of serum bilirubin concentration within the physiological range can effectively retard the progression of Diabetic Kidney Disease (DKD). Furthermore, the hormonal attributes of bilirubin may underlie its renoprotective effects.

Determination of Serum Biochemical Profile and Oxidant-Antioxidant Activities in Damascus Goats at Different Ages

This study aimed to research changes in biochemical profile and oxidant-antioxidant activities of Damascus goats of different ages. The 45 non-gravid Damascus goats of different ages were included in the research. They were divided into three groups of 15 goats according to age: goat kids ( - ≤ 6-months age), young goats (2-3-year age) and old goats (5-8-year age). Biochemical parameters and oxidant-antioxidant activities were determined in serum samples using commercial kits and colorimetric methods. The lowest serum urea, blood urea nitrogen, aspartate aminotransferase, total protein, albumin, globulin and magnesium levels were observed in goat kids (P &amp;lt; .05). Concentrations of glucose, inorganic phosphorus, non-esterified fatty acids, albumin/globulin and alanine aminotransferase decreased with age in the goats (P &amp;lt; .05). Serum total oxidant capacity, total antioxidants capacity and oxidative stress index levels were increased in goat kids compared to old goats (P &amp;lt; .05). Furthermore the highest serum glutathione and glutathione preoxidase activities were observed in young goats (P &amp;lt; .05). An increase was determined in concentrations of serum β-carotene and bilirubin in old goats compared to goat kids (P &amp;lt; .05). In contrast, serum catalase activity, arylesterase, ceruloplasmin and uric acid values did not differ between the groups. The results obtained on the biochemical profiles and oxidant-antioxidant activities of Damascus goats will contribute to monitoring this breed's age-related health and nutritional status and establishing reference values.

Alteration of Serum Bilirubin and Myeloperoxidase Concentration Associated Moderate Intensity Exercise Among Novice Students Athletes

Alteration of Serum Bilirubin and Myeloperoxidase Concentration Associated Moderate Intensity Exercise Among Novice Students Athletes

Validity of BiliDx as a point-of-care bilirubin measurement device to diagnose and monitor neonatal jaundice at Muhimbili National Hospital, an observational study

BackgroundNeonatal jaundice is a condition caused by elevated levels of bilirubin in the bloodstream. Laboratory determination of serum bilirubin concentration by total serum bilirubin (TSB) test is still considered as gold standard for clinical guidance and practice. In developed countries, diagnosis of neonatal jaundice is shifting towards point-of-care medical devices. BiliDx is a device developed to allow a fast, blood-based determination of bilirubin levels at the point of care. This study aimed to determine the accuracy of the BiliDx device relative to a standard laboratory total serum bilirubin to diagnose and monitor jaundice among neonates admitted at Muhimbili National Hospital (MNH).Material and methodologyThis was a prospective hospital-based observational study conducted at the Neonatal Ward – MNH, Dar-es-Salaam, Tanzania from November 2022 to January 2023. A total of 180 neonates admitted at the neonatal ward with jaundice and whose parents consented were enrolled in the study. Blood samples were collected; 2 ml of venous blood into the vacutainer bottle for standard laboratory measurement of total serum bilirubin (TSB) and 25µL blood collected into a transfer pipette tube and applied to BiliDx. STATA version 15.1 was used for data analysis.ResultsOut of 180 neonates, 39.4% (71/180) had birth weight between 1500 − 2499.9 g, approximately 2/3rd (120/180) were preterm, 92/180 (51.1%) were males and 100/180 (55.6%) were undergoing phototherapy treatment the moment sample taken. The mean bilirubin concentration was 92 mmol/l for BiliDx and 118 mmol/l for standard laboratory TSB. The minimum and maximum values obtained with BiliDx were, 3.4 and 427.5 mmol/l respectively, compared with 10.7 and 382.1 mmol/l using standard laboratory TSB. A linear relationship and correlation coefficient of 0.8408 (p = 0.000) between BiliDx and standard laboratory TSB was found. The regression analysis showed the presence of constant error [coefficient of BiliDx/slope = 0.91, 95% CI (0.82–0.99), p = 0.000] and random error exclusively [coefficient of constant/y-intercept = 48.52, 95%CI (37.70-59.34), p = 0.000]. The Bland–Altman plot showed an acceptable mean difference of 39.1mmol/l, limits of agreement of -48.3mmol/l to 126.4mmol/l, and 179 points (179/180 = 99.4%) lying inside the limits of agreement.ConclusionThe results support the use of BiliDx for rapid and accurate testing of elevated levels of bilirubin in the bloodstream among neonates since 99.4% of the differences between BiliDx and standard laboratory TSB lie between the lines of agreement.

Role of Natural Compounds Modulating Heme Catabolic Pathway in Gut, Liver, Cardiovascular, and Brain Diseases.

The crucial physiological process of heme breakdown yields biliverdin (BV) and bilirubin (BR) as byproducts. BV, BR, and the enzymes involved in their production (the "yellow players-YP") are increasingly documented as endogenous modulators of human health. Mildly elevated serum bilirubin concentration has been correlated with a reduced risk of multiple chronic pro-oxidant and pro-inflammatory diseases, especially in the elderly. BR and BV per se have been demonstrated to protect against neurodegenerative diseases, in which heme oxygenase (HMOX), the main enzyme in the production of pigments, is almost always altered. HMOX upregulation has been interpreted as a tentative defense against the ongoing pathologic mechanisms. With the demonstration that multiple cells possess YP, their propensity to be modulated, and their broad spectrum of activity on multiple signaling pathways, the YP have assumed the role of an adjustable system that can promote health in adults. Based on that, there is an ongoing effort to induce their activity as a therapeutic option, and natural compounds are an attractive alternative to the goal, possibly requiring only minimal changes in the life style. We review the most recent evidence of the potential of natural compounds in targeting the YP in the context of the most common pathologic condition of adult and elderly life.

Atorvastatin inhibits Lipopolysaccharide (LPS)-induced vascular inflammation to protect endothelium by inducing Heme Oxygenase-1 (HO-1) expression.

This study aimed to explore the differential effects of varying doses of atorvastatin on antagonizing lipopolysaccharide (LPS)-induced endothelial inflammation based on heme oxygenase 1 (HO-1) expression. Vascular endothelial inflammatory injury was induced in 40 Sprague-Dawley rats by intraperitoneal injection of LPS. These rats were randomly divided into control, low-dose atorvastatin, high-dose atorvastatin, and HO-1 blocking groups. Seven days after treatment, all rats were sacrificed, and heart-derived peripheral blood was collected to measure the serum concentrations of bilirubin, alanine aminotransferase (ALT), total cholesterol, malondialdehyde, endothelial cell protein C receptor, endothelin-1, von Willebrand factor, and soluble thrombomodulin. Meanwhile, the number of circulating endothelial cells was determined using flow cytometry. Vascular tissues from descending aorta of rats from each group were extracted to detect the expression level of HO-1. After different doses of atorvastatin intervention, the above inflammatory indices were decreased, and HO-1 expression and ALT concentration were increased in the atorvastatin-treated group of rats compared with the control group. These changes were more pronounced in the high-dose statin group (P < 0.05). Conversely, no significant decrease in the above inflammatory indices and no significant increase in HO-1 expression were observed in rats in the blocking group (P > 0.05). For LPS-induced vascular inflammation, high-dose atorvastatin exerts potent anti-inflammatory and vascular endothelial protection effects by inducing HO-1 expression.

Relationship between bilirubin and systemic lupus erythematosus: A systematic review and meta-analysis.

Systemic lupus erythematosus (SLE) is an autoimmune disease with a high prevalence worldwide. This study aimed to examine the correlation between serum bilirubin levels and SLE. The Cochrane library, Embase, PubMed, and China National Knowledge Infrastructure (CNKI) databases were examined and assessed until March 2023. RevMan 5.3 software was utilized for the analysis of clinical trails. Five case-control studies were chosen and incorporated, examining the levels of serum bilirubin in patients with SLE compared to healthy individuals, as well as in active SLE patients versus inactive ones, in different sexes and in SLE patients with or without lupus nephritis (LN). The results of this meta-analysis demonstrated that serum bilirubin in healthy individuals were obviously increased compared to SLE patients (MD = 4.76; 95% CI, 3.15-6.38, p < .00001). Additionally, inactive SLE patients had higher levels of bilirubin than active SLE patients (MD = 3.15; 95% CI, 0.46-5.84, p = .02), and SLE patients without lupus nephritis had higher levels of serum bilirubin than those with lupus nephritis (MD = 4.91;95% CI, 2.87-6.95, p < .00001). Nevertheless, there were no disparities observed among SLE patients of varying sexes (MD = 0.34; 95% CI, -0.01 to 0.69, p = .06). The concentration of serum bilirubin may potentially be used as an indicator for estimating the advancement of SLE and reflecting the presence of kidney complications in individuals with SLE. Furthermore, more high quality studies were needed to identify these findings.

Immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura — diagnostic difficulties and errors

Introduction. When establishing a diagnosis of thrombotic thrombocytopenic purpura (TTP) for the first time, other diseases occurring with thrombocytopenia may be misdiagnosed. Aim: to analyze diagnostic difficulties and errors of TTP. Materials and methods. In total, 54 patients (44 women and 10 men) aged 18 to 83 years (median 33 years), who were diagnosed TTP from 2019 to 2023, were included in the study. Anamnesis, baseline hemoglobin, platelets, erythrocytes, lactate dehydrogenase and bilirubin serum concentrations, pre-established diagnoses, treatment, and outcomes were analyzed. Results. Initially TTP was suspected only in 19 (35 %) patients. In 12 out of 54 patients immune thrombocytopenia (ITP) was initially misdiagnosed. Fisher-Evans syndrome was initially suspected in 3 patients. In sporadic cases, myelodysplastic syndrome, systemic lupus erythematosus / antiphospholipid syndrome, autoimmune hemolytic anemia were initially suspected. Among 15 women with associated with pregnancy TTP in 8 (53.3 %), HELLP syndrome was initially misdiagnosed. In total, 12 (22.2 %) of 54 TTP patients died. In 11/12 non-survival patients, TTP treatment was never started, because the doctors were waiting for the ADAMTS13 test results. A case report of Sequential Immune Thrombocytopenia (ITP) and TTP in the same Patient is described. Conclusion. When thrombocytopenia is combined with hemolysis and in the absence of multiple organ pathology, it is difficult to differentiate ITP and TTP without examining the plasma activity of ADAMTS113. With a combination of ITP and TTP in the same patient, the study of ADAMTS13 plasma activity makes it possible to identify the leading mechanism of thrombocytopenia and choose treatment tactics.

Correlation between Bilirubin Elimination with the Cytokine Adsorber CytoSorb® and Mortality in Critically Ill Patients with Hyperbilirubinemia

Introduction: Hyperbilirubinemia is often the first evidence for any kind of liver disorder and over one-third of all patients in intensive care units (ICU) show elevated bilirubin concentrations. In critically ill patients, high concentrations of serum bilirubin are correlated with a poor outcome. Therapies to lower bilirubin concentrations are often just symptomatically and their effect on the patients’ outcome is hardly evaluated. Therefore, this study investigates whether the extracorporeal elimination of bilirubin with the cytokine adsorber CytoSorb^® (CS) reduces mortality in patients with hyperbilirubinemia. Methods: Patients with bilirubin concentrations >10 mg/dL at the ICU were screened for evaluation from 2018 to 2020. Patients with kidney replacement therapy and older than 18 years were included. Patients with continuously decreasing bilirubin concentrations after liver transplantation or other liver support systems (i.e., Molecular Adsorbents Recirculating System [MARS^®], Advanced Organ Support [ADVOS]) were excluded. CS therapy was used in clinical routine and was indicated by the treating physicians. Statistical analysis was performed with IBM SPSS statistics utilizing a multivariate model. Primary outcome measure was the effect of CS on the 30-day mortality. Results: Data from 82 patients (mean Simplified Acute Physiology Score [SAPS] II: 74 points, mean bilirubin: 18 mg/dL, mean lactate: 3.7 mmol/L) were analyzed. There were no significant differences in patients with and without CS treatment. The multivariate model showed no significant effect of CS therapy (p = 0.402) on the 30-day mortality. In addition, a significant effect of bilirubin concentration (p = 0.274) or Model for End-Stage Liver Disease score (p = 0.928) on the 30-day mortality could not be shown. In contrast, lactate concentration (p = 0.001, b = 0.044) and SAPS II (p = 0.025, b = 0.008) had significant impact on 30-day mortality. Conclusion: The use of CS in patients with hyperbilirubinemia did not result in a significant reduction in 30-day mortality. Randomized and controlled studies with mortality as primary outcome measure are needed in the future to justify their use.

Investigation of correlation study among transcutaneous and total serum bilirubin content in preterm neonates

Background. Neonatal jaundice is a commonly occurring problem in both full term and preterm neonates. It is one of the major causes for neonatal mortality and morbidity. Objective. To assess the correlation among transcutaneous bilirubinometer readings and Total serum bilirubin levels at different sites in early and late preterm neonates before and at the end of phototherapy. Method. An observational study was conducted in preterm neonates diagnosed with jaundice. The Transcutaneous Bilirubin (TCB) instrument, Drager JM105 is used to assess TCB and it was recorded on three sites and average of the three readings was noted. Prior to phototherapy, TCB was noted 30 min before TSB was sent. A photo-opaque patch was placed on the sternum and phototherapy was given. At the end of the phototherapy, TCB on the sternum was noted and then TSB was sent with a time gap of not more than 30 min. Results. In this study, out of 50 neonates 14 were early preterm and 36 were late preterm babies. It was found that there was a positive correlation between TCB and TSB in early preterm babies before phototherapy (p value=0.0019), but there was no correlation between TCB and TSB at the end of phototherapy. In late preterm babies there was no correlation between TCB and TSB both before phototherapy and at the end of phototherapy. Conclusion. In this study it was found that TCB has positive correlation with TSB and can be implemented for the screening of hyperbilirubinemia even in preterm neonates.

Noninvasive transcutaneous bilirubin measurement in adults using skin diffuse reflectance.

Accurate measurement of bilirubin concentration in adults is crucial for the diagnosis and management of liver and biliary tract diseases. Traditional methods relying on central laboratory testing pose challenges such as invasiveness, patient discomfort, and time consumption. Non-invasive alternatives have been explored, but their applicability to adult populations remains uncertain. This study aimed to develop and validate a portable non-invasive optical system based on spatially resolved diffuse reflectance spectroscopy (DRS) specifically tailored for adult transcutaneous bilirubin measurement. Forty-two adult patients with various underlying conditions were included in the study. Comparisons between transcutaneous bilirubin values measured by the DRS system and total serum bilirubin concentrations obtained through blood tests revealed strong correlations, particularly at the neck (r = 0.872) and the medial side of the right upper arm (r = 0.940). Bland-Altman analyses demonstrated substantial agreement between the transcutaneous bilirubin values and total serum bilirubin concentrations. The results highlight the potential of the non-invasive DRS system as a convenient and reliable tool for monitoring bilirubin values in adults.