Decrease In Serum Bilirubin Levels Research Articles

Effect of nanoparticle macroalgae in the treatment of fatty liver disease using logistic regression, and support vector machine

One of the major health issues facing people worldwide is liver fibrosis. Liver fibrosis may be brought on by long-term exposure to harmful substances, medicines, and microorganisms. The development of liver fibrosis in children was particularly worrying due to their longer life-span, which was possibly related to a great risk of developing long-term complications. Marine algae species have provided a biological variety in the research phase of novel approaches to the treatment of numerous ailments. Marine macroalgae have recently been the subject of research due to their rich bioactive chemical composition and potential for the production of various nutraceuticals. Macroalgae are potentially excellent sources of bioactive substances with particular and distinct biological activity when compared to their terrestrial equivalents. Macroalgae in diverse marine cases offer a few biologically active metabolites, comprising sterols, polyunsaturated fatty acids, carotenoids, oligosaccharides, polysaccharides, proteins, polyphenols, vitamins, and minerals. Accordingly, there is great interest in their high potential for supporting immunomodulatory, antimicrobial, antidiabetic, antitumoral, anti-inflammatory, antiangiogenic, and neuroprotective properties. Using an experimental model, the current research intends to collect data on the therapeutic value of macroalgae nanoparticles for fatty liver disease. The researchers' goal of predicting illnesses from the extensive medical datasets is quite difficult. The purpose of this research is to assess the protective effects of a seaweed, Padina pavonia (PP), on liver fibrosis caused by carbon tetrachloride (CCl4). This research presents two models of logistic regression (LR) and support vector machines (SVM) for predicting the likelihood of liver disease incidence. The performance of the model was evaluated using a dataset. PP macro-algae considerably reduce the high blood concentrations of aminotransferases, alkaline phosphatases, and lactate dehydrogenases, as well as causing a considerable (p < 0.05) decrease in serum bilirubin levels. In addition to improving kidney function (urea and creatinine), algal extracts enhance fat metabolism (triglycerides and cholesterol). With an accuracy rate of 70.2%, a sensitivity of 92.3%, a specificity of 74.7%, a type I error of 9.1%, and a type II error of 21.0%, the predictive model has demonstrated excellent performance. The model validated laboratory tests' ability to predict illness (age; direct bilirubin (DB), total proteins (TP), and albumin (ALB). These classifier methods are compared on the basis of their execution time and classification accuracy.

The potential role of vitamin E in patients with glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis.

As an antioxidant, vitamin E (VitE) may benefit the erythrocytes by protecting glutathione from oxidation by free radicals and peroxide-generating processes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines when reporting this systematic review. We searched 6 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) until May 8, 2022. We included all relevant studies. According to the study design, the Cochrane assessment tool (Risk of Bias 2), Risk Of Bias In Non-randomized Studies - of Interventions checklists, and National Institutes of Health tools were used to assess the risk of bias.Continuous data were pooled as a mean difference (MD) with a relative 95% confidence interval. The protocol was registered on PROSPERO (CRD42022333848). Six studies were included in the meta-analysis with a total of 181 patients. Compared with the control group, VitE significantly improved the hemoglobin level for chronic hemolysis (MD = 2.72 g/dL, P < .0001) and for acute hemolysis (MD = 1.18 g/dL, P < .0001). It also decreased the reticulocyte level for chronic hemolysis (MD = -1.39 P < .0001) and for acute hemolysis (MD = -1.42%, P < .0001). For before and after studies, the use of VitE significantly improved the level of packed cell volume (MD = 0.56%, P < .00001), red blood cell half-life (MD = 2.19 days, P < .0001), and decreased the reticulocytes level (MD = -1.41%, P < .00001). Among patients with glucose-6-phosphate dehydrogenase deficiency, VitE might provide benefits such as increasing the hemoglobin, packed cell volume levels, red blood cell half-life, and decreasing the reticulocyte level, so reducing hemolysis. Further high-quality, well-designed randomized controlled trials are recommended.

Preoperative Cholangiostomy for Pancreatic Head Cancer

The question of the need for routine preoperative drainage of the biliary tree in peripapillary tumor obstruction is still debatable. We conducted a retrospective randomized single–center study, the first control point of which was to study the safety of percutaneous drainage, the second was the effect of preoperative drainage on the number of postoperative complications in pancreatoduodenectomy (PD). The results of 85 Whipple’s PD for a tumor of the head of the pancreas were analyzed. Preoperative biliary drainage (PBD) was performed in 75 (88.2 %) cases and was represented by percutaneous transhepatic cholangiostomy. 10 (11.8 %) patients did not undergo PBD. In the preoperative period, the level of plasma bilirubin and the severity of mechanical jaundice were assessed according to E.I. Galperin, 2014. The frequency of postoperative complications was assessed, both after performing PBD and after PD, the severity was graded according to the Clavien–Dindo scale. The technical success of cholangiostomy was achieved in 100 % of cases, the clinical efficacy of PBD is represented by a significant decrease in serum bilirubin levels and a decrease in the severity of jaundice. Complications of transcutaneous interventions on the biliary tree corresponded to III A of the Clavien– Dindo scale and did not affect the preoperative status. Complications of PD among patients without PBD corresponded to classes IIIA and V of the Clavien–Dindo scale: failure of pancreatojejunostomy (30 %, 3 out of 10) with the formation of pancreatic fistula, complete or partial failure of hepaticojejunostomy (30 %, 3 out of 10). Infectious complications in the form of abdominal abscesses and suppuration of a postoperative wound were found in 20 % (2 out of 10). In patients after PBD, PD complications corresponded to classes IIIA and IIIB of the Clavien–Dindo scale: partial failure of pancreatojejunostomy and pancreatic accumulations of the abdominal cavity (18.7 %), acute pancreatitis (12 %) and focal pancreatic necrosis (12 %), partial failure of hepaticojejunostomy (6.7 %). Abscesses of the abdominal cavity and retroperitoneal space, infection of the wound were noted in 14.7 %. After PD, the mortality rate was 6 (7.1 %) cases, of which 3 (30 %, 3 out of 10) patients without PBD and 3 (4 %) patients with cholangiostomy. Using contingency tables with the calculation of Fisher’s exact test and Pearson’s contingency coefficient, it was found that PBD does not affect the frequency of complications from pancreatojejunostomy and the development of infectious complications; the absence of cholangiostomy significantly leads to an increase in the frequency of hepaticojejunostomy failure.

Effect of Intravenous Fluid Adjuvant Therapy on Decreasing Serum Bilirubin during Intensive Phototherapy in Healthy Term Neonate with Severe Nonhemolytic Hyperbilirubinemia.

Phototherapy is the most common form of treatment and prevention of neonatal nonconjugated hyperbilirubinemia. It seems that intravenous fluid therapy as a complementary method of phototherapy can accelerate the healing process in affected infants. This study aimed at investigating intravenous fluid therapy's effect in decreasing serum bilirubin in healthy term neonates with nonhemolytic hyperbilirubinemia under intensive phototherapy. As many as 160 healthy term infants with severe nonhemolytic hyperbilirubinemia and without exclusion criteria were enrolled. Infants were randomized to the two treatment groups (phototherapy alone and combination with intravenous fluid therapy). Serum bilirubin at admission time, 6, 12, 24, and 48 h later were measured. We evaluated decreasing serum bilirubin levels and duration of hospitalization in both groups. In this study, the mean levels of serum bilirubin on admission time, 6, 12, 24, and 48 h after treatment gradually reduced in both groups; still, the decrease was not statistically significant between the two groups. Intravenous fluids therapy does not have a significant advantage in the process of phototherapy in healthy term neonates with severe nonhemolytic hyperbilirubinemia.

Hypothermic oxygenated machine perfusion for extended criteria donor allografts: Preliminary experience with extended organ preservation times in the setting of organ reallocation.

In times of critical organ shortage, poor organ pool utilization and increased use of extended-criteria donor (ECD) allografts remain a major problem. Hypothermic oxygenated machine perfusion (HOPE) has emerged as a promising and feasible strategy in ECD liver transplantation (LT). However, potential safety limits regarding the duration of perfusion are yet to be explored. Besides marginal allograft quality (steatosis), prolonged cold ischemia time remains the most important factor for a high number of liver allografts being declined for transplantation. Two ECD-allografts were each allocated to two recipients, who proved to be unsuitable to receive the assigned allograft upon arrival at the transplant center. The organs were reallocated by Eurotransplant and accepted by our center for two different backup patients. During that time, HOPE was commenced and continued until the recipient hepatectomy was completed. Postoperative allograft function was assessed by serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and International Normalized Ratio. Incidence of early allograft dysfunction (EAD), postoperative complications, and length of hospital stay were analyzed. HOPE was applied for 4h 35min and 4h 20min, resulting in a total cold preservation time of 17h 29min and 15h 20min, respectively. Both recipients displayed decreasing serum transaminases and bilirubin levels postoperatively. No EAD or major postoperative complications occurred in either patient. Serum ALT and AST levels were within the normal range at discharge. Extended HOPE enables the safe extension of preservation time for up to 18h in human LT. End-ischemic HOPE may significantly improve organ pool utilization, while simultaneously facilitating operating room logistics and preventing organ injury.

Decreased serum bilirubin levels in children with lead poisoning.

ObjectiveLead is a toxic heavy metal, which causes irreversible damage in children. Oxidative stress is the underlying mechanism of lead toxicity, and monitoring oxidative stress of lead poisoning children in vivo is important. Our study aimed to investigate blood serum levels of biochemical parameters, including albumin, bilirubin, creatinine, and uric acid, which are regarded as non-enzymatic antioxidants, in children with lead poisoning.MethodsWe studied 355 children with lead poisoning and 355 age- and sex-matched controls. We analyzed clinical characteristics and measured serum levels of total protein, globulin, albumin, bilirubin, aspartate aminotransferase (AST), alanine aminotransferase, urea, and creatinine.ResultsWe found that albumin, bilirubin, urea, and creatinine levels were significantly lower and AST, total protein, and globulin levels were higher in children with lead poisoning than in controls. Direct bilirubin, albumin, total protein, urea, creatinine, and AST levels were associated with lead poisoning after adjustment for other covariates. Spearman analysis showed that direct bilirubin, albumin, and urea levels were independent indicators (i.e., not related to hemoglobin or weight), while creatinine levels showed a moderate correlation with weight.ConclusionLead interferes with the non-enzymatic antioxidant system in children, and lead poisoning results in a decrease in serum bilirubin levels.

The Effect of Light Exposure to Bilirubine Levels on Serum Jaundice Infant in Hospital of Islamic NU Demak

Bilirubin is a substance formed from the normal breakdown of erythrocytes in the body so that it gives a yellow color to the stool and urine. The test of bilirubin in the laboratory must avoid exposure to light, which can cause decreased serum bilirubin levels by up to 50% in 1 hour due to disruption of the bilirubin's stability. This study is a cross-sectional analytic study of primary data using 30 samples of jaundice baby serum and direct and total bilirubin test. Data collection was conducted from the primary data by a direct test using 40 samples of infant jaundice and test of direct bilirubin and total bilirubin using methods Dichlorophenyl Diazonium. The results of the tests of 40 samples can result in the mean levels of total bilirubin were exposed to the light of 8.58 mg/dl and were not exposed to light 12,67mg /dl. Direct bilirubin levels mean that exposure to light is 3.98 mg/dl. In contrast, the unexposed light of 8.71 mg/dl, so that it can be concluded that the levels of total and direct bilirubin in serum jaundice infants exposed to lower light compared with those not exposed to light.

A clinical investigation to assess the association between serum bilirubin levels and coronary artery disease: A case-control study

Aims: The aim of the present study was to assess the association between serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease. Material and methods: A cross-sectional study was conducted in the Department of medicine, India from Jan 2019 to Jan 2020. Total of 160 subjects were included in the study with 80 cases and 80 controls. General and systemic examination was conducted on all study subjects including laboratory investigations like complete blood count, renal function test, lipid profile, viral markers such as HBsAG, HCVIgM and liver function test which includes total bilirubin, direct and indirect, liver enzymes, albumin and globulin levels. Results: The mean age among the cases male and female respectively was 62.76±8.2 and 63.85±8.3 and controls group were 61.85±8.4 and 62.38±8.5 years male and female respectively. 60% were male and 40% female in case group and 63.75% patients were male and 36.25% patients were female in control. The most common risk factors for CVD like diabetes, hypertension, smoking, obesity and family history of CVD was found to be slightly higher among the cases than the control groups but it was not found to be statistically significant and it proves that the controls were matched for almost all the risk factors for CVD except for dyslipidemia which was found to be significantly higher among the CVD patients than the controls. The mean duration of CVD was 4.4±2.8 years. The various liver function test parameters were compared between the cases and controls it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin was found to be lower among the case group compared to the control group and this difference was found to be statistically significant, whereas the other parameters like SGOT, SGPT and GGT levels did not show much difference between the case and control groups and the difference in values were not statistically significant. Conclusion: The relationship between the decreased serum bilirubin levels and the event of CAD; in this manner, bilirubin level can fill in as a prognostic factor, together with other significant factors for recognizing an individual who is in the peril of coronary artery disease.

Dexamethasone for postoperative hyperbilirubinemia in patients after liver resection: An open-label, randomized controlled trial

BackgroundAlthough prophylactic glucocorticoids have been used before liver resection to minimize liver dysfunction, it is unknown whether treatment with glucocorticoids will accelerates recovery from hyperbilirubinemia after liver resection. MethodsIn this open-label, randomized, controlled trial, patients with hyperbilirubinemia (>2.5 × and ≤5 × the upper limit of normal) within 7 days after hepatic resection were assigned randomly to the dexamethasone or control groups. For the dexamethasone group, 10 mg, 10 mg, and 5 mg dexamethasone were administered intravenously on days 0, 1, and 2, respectively, after randomization. For the control group, patients received standard treatment only. The primary outcome was time to recovery from hyperbilirubinemia defined as the period from the day of randomization to the day when serum bilirubin decreased to ≤1.5 times that of the upper limit of normal. Secondary outcomes were the prevalence of postoperative complications, postoperative hospital stay, and hospital expense. ResultsBetween March 2016 and December 2017, 76 participants were enrolled (38 in each group). Median time to recovery from hyperbilirubinemia was less in the dexamethasone group than in the control group (2 vs 4 days, P < .001). Serum bilirubin levels were less in the dexamethasone group on days 1–3 after randomization (P < .05). The prevalence of infection, posthepatectomy liver failure, postoperative hospital stay, and hospital expense were not different between the groups. ConclusionDexamethasone accelerated recovery from hyperbilirubinemia and decreased serum bilirubin levels without causing more side effects in patients after hepatectomy.

Decreased Serum Bilirubin Levels and Increased Uric Acid Levels are Associated with Ulcerative Colitis.

BackgroundIn recent years, emerging evidence has suggested that ulcerative colitis occurs as a consequence of an imbalance between oxidative stress and antioxidant capacity. The objective of this study was to investigate whether serum total bilirubin and serum uric acid levels were associated with ulcerative colitis.Material/MethodsWe conducted a retrospective case-control study which included 170 patients with ulcerative colitis and 200 healthy individuals. Concentrations of serum total bilirubin and serum uric acid were obtained from biochemical information and segregated into quartiles. Logistic regression analysis was adopted to explore the correlations between levels of the 2 biochemical markers and the risk of ulcerative colitis.ResultsCompared with healthy controls, patients with ulcerative colitis exhibited lower levels of serum bilirubin (9.30 umol/L versus 12.49 umol/L respectively, P<0.001). Multivariate logistic regression showed that the lowest quartile of total serum bilirubin was independently associated with the occurrence of ulcerative colitis (OR=2.56, 95%CI: 1.54–4.25, P<0.001). Similarly, ulcerative colitis patients exhibited higher concentrations of serum uric acid (338 umol/L versus 300 umol/L respectively, P=0.041). Multivariate logistic regression showed that the highest quartile of serum uric acid was independently associated with ulcerative colitis risk (OR=1.20, 95%CI: 1.05–1.77, P=0.045). Furthermore, a negative association was observed between serum total bilirubin and serum uric acid in patients with ulcerative colitis.ConclusionLower levels of serum total bilirubin and higher levels of serum uric acid are associated with ulcerative colitis patients compared to healthy controls.

The Effect of Gut Bacterial β‐Glucuronidase on Serum Bilirubin Levels

The results of several large population studies have consistently demonstrated an inverse correlation between serum bilirubin levels and the development of cardiovascular and metabolic diseases. The goal of this study was to test the hypothesis that increased bacterial β‐Glucuronidase (β‐glu) activity can increase the levels of serum bilirubin by decreasing conjugation of bilirubin in the gut. Two strains of Lactobacillus acidophilus with different levels of β‐glu activity, NCK 56 (control) and NCK 2136 (constitutive overexpression), were grown and administered to mice once per day for five days. Each mouse was then administered 2 mL of fluid containing 500 million cells/ml via gastric gavage. Plasma samples were obtained prior to and after treatment. Serum bilirubin levels were measured using a specific assay kit via absorption at 700 nm. Serum bilirubin levels were similar in both groups prior to treatment averaging 2.3 +0.1 and 2.1 + 0.2 mg/dL in 56 and 2136 treated mice, respectively (n=3/group, p=0.8). Five day treatment of mice with control 56 L. acidophilus resulted in a significant decrease in serum bilirubin levels to 1.7 + 0.5 mg/dL (p&lt;0.05), while treatment with β‐glu overexpressing L. acidophilus did not change serum bilirubin levels which averaged 2.3 + 0.3 mg/dL. Our results demonstrate that β‐Glu expression by modified L. acidophilus prevented the decrease in bilirubin that is seen upon administration of the control L. acidophilus bacterial strain. Overexpression β‐glu in a different host bacteria species with less reducing activity may provide a way to elevate serum bilirubin levels.Support or Funding InformationHearin Support Foundation, Medical Student Research Program, University of Mississippi Medical Center School of Medicine. National Heart, Lung, and Blood Institute, IP01HL‐051971. National Institute of General Medical Sciences, P20GM‐104357.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Inverse Relationship Between Serum Bilirubin Levels and Diabetic Foot in Chinese Patients with Type 2 Diabetes Mellitus.

BackgroundSeveral studies demonstrated that bilirubin, a potent endogenous antioxidant, is a strong protective factor for many diabetic complications such as nephropathy, retinopathy, neuropathy, and vasculopathy. The purpose of this study was to assess the association between serum bilirubin levels and diabetic foot (DF) in Chinese patients with type 2 diabetes mellitus (T2DM).Material/MethodsThe present cross-sectional study of bilirubin levels in relation to DF was conducted in 1,269 T2DM patients with (n=578) and without (n=691) DF. Blood test results were obtained on hospital admission, including total bilirubin (T-BIL), direct bilirubin (D-BIL), and indirect bilirubin (I-BIL). Data on Wagner classification and amputation procedure in patients with DF were collected by reviewing electronic medical records. Univariate or multivariate analysis were performed to explore the association between bilirubin and DF.ResultsSerum I-BIL levels were shown to play a protective role regarding the presence and severity of DF (OR=0.75, p=0.029 and OR=0.90, p=0.021, respectively). In addition, in a comparison of the lowest and highest tertiles of serum bilirubin concentration, the highest tertile of serum T-BIL (OR=0.51, p=0.011) and I-BIL (OR=0.28, p<0.001) was significantly related with a lower Wagner grade of DF. Patients with DF in the highest tertiles of T-BIL carried a significantly lower risk of amputation events than those in the lowest tertiles (OR=0.47, p=0.025).ConclusionsThe present study provided evidence that decreased serum bilirubin levels were independently associated with the presence and severity of DF and amputation events in patients with DF.

The Effect of Oral Zinc Sulfate on Serum Bilirubine Level in Term Neonates with Jaundice

Background The most commonly used treatment for neonatal hyperbilirubinemia (NH) are phototherapy and exchange transfusion. Among the drug therapy for NH less has been paid to the effect of zinc administration on serum bilirubin level (SBL). This study was carried out to determine the on the effect of oral zinc sulfate on the SBL in term neonates with hyperbilirubinemia. Materials and Methods In this randomized clinical trial, we studied term neonate with jaundice hospitalized in Amirkola Children’s Hospital, Babol-Iran for phototherapy. Eligible neonates were randomly divided into two; intervention (n=30) and control (n=30) groups. Both groups received standard conventional phototherapy but the intervention group received 5 mg per day oral zinc sulfate until discharge. The outcome variables were SBL and the duration of phototherapy. Results Out of the 105 studied neonates, 50 cases were in the intervention group and 55 patients were in the control group. The mean SBL before intervention in the intervention and control groups, was 17.4 ±2.1 and 17.1±2.2 mg/dl, respectively (P>0.05) but after the intervention, it decreased to 8.8±0.77 and 8.7±0.99 in intervention and control groups respectively (P>0.05). The mean differences in the decrease in SBL between the two groups were 8.8 and 8.3 in intervention and control groups respectively (P>0.05). But the mean duration of phototherapy in the intervention group and the control group was 4.1 days and 3.6 days respectively (P<0.05). Conclusion Administration of oral zinc in neonatal hyperbilirubinemia under the phototherapy could decrease the duration of phototherapy. Further studies are needed to recommend it as an adjunctive therapy to phototherapy.

Anemia, bilirubin, and cardiovascular autonomic neuropathy in patients with type 2 diabetes.

To investigate the relationship among anemia, physiological serum bilirubin levels, and cardiovascular autonomic neuropathy (CAN) in subjects with type 2 diabetes. In total, 2230 subjects with type 2 diabetes were evaluated in this cross-sectional study. CAN was diagnosed with a cardiovascular reflex test. The prevalence of anemia was greater in subjects with CAN. In multivariable analysis, the relationship between anemia and CAN remained statistically significant after adjusting for the risk factors (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07–1.80, P = .015). Additional adjustment for serum bilirubin concentrations abolished this relationship (OR 1.20, 95% CI 0.91–1.58, P = .189). Anemia is positively associated with the prevalence of CAN in subjects with type 2 diabetes. In addition, our results suggest that the putative increased CAN risk associated with anemia might be mediated by a correlated decrease in serum bilirubin levels.

Short- and Long-Term Outcome of Balloon Dilatation of Benign Biliary Strictures

Background: The rate of benign biliary strictures has increased in recent years. Objectives: We studied the short- and long-term efficacy of biliary balloon dilatation in patients suffering from benign biliary strictures due to prior abdominal surgeries, such as laparoscopic cholecystectomy or liver transplantation. Patients and Methods: An initial baseline biochemistry profile and ultrasound examination of the biliary system was done before each procedure, and 3 and 6 month follow-up sessions were completed after the completion of the biliary balloon dilatation procedure. Serum bilirubin, liver enzyme levels, and ultrasonography findings were investigated during every session. Results: Twenty four patients, 17 females (70.8%) and 7 males (29.2%), were included in this study. In 21 (88%) of the patients, the biliary stricture was developed after a laparoscopic cholecystectomy, while in 2 (8%) it was a complication of a liver transplantation. The remaining patients (4%) developed it after autoimmune pancreatitis (Whipple surgery). Among the 24 patients, 2 died within 2 months after the ballooning, mainly due to complications of their previous surgery and secondary liver cirrhosis. We found a significant decrease in serum bilirubin levels after balloon dilatation (P < 0.0001). All the patients showed normal ultrasonography findings after the procedure, and all reported complete relief of symptoms after a 6-month period. Conclusion: Serum bilirubin levels were significantly decreased after balloon dilatation. This procedure has led to a success rate of 95% in the short term and 91% in the long term.

Serum bilirubin: a simple routine surrogate marker of the progression of chronic kidney disease

Background: Studies suggest that Chronic Kidney Disease (CKD) is a global burden health associated with significant comorbid conditions. Few biochemical parameters have gained significance in predicting the disease progression. The present work aimed to study the association of the simple biochemical parameter of serum bilirubin level with the estimated glomerular filtration rate (eGFR), and to assess their association with the co-morbid conditions in CKD.Methods: We recruited 188 patients with CKD who attended a Nephrology out-patient department. eGFR values were calculated based on the serum creatinine levels using CKD-EPI formula. Various biochemical parameters including glucose, creatinine, uric acid, total and direct bilirubin were assayed in all study subjects. Study subjects were categorized into subgroups based on their eGFR values and their diabetic status and the parameters were compared among the different subgroups.Results: We observed a significantly decreased serum bilirubin levels (p < 0.001) in patients with lower eGFR values, compared to those with higher eGFR levels. There was a significant positive correlation between the eGFR levels and the total bilirubin levels (r = 0.92). We also observed a significant positive correlation between the eGFR levels and the direct bilirubin levels (r = 0.76). On multivariate linear regression analysis, we found that total and direct bilirubin independently predict eGFR, after adjusting for potential confounders (p < 0.001).Conclusions: Our results suggest that there is significant hypobilirubinemia in CKD, especially with increasing severity and co-existing diabetes mellitus. This finding has importance in the clinical setting, as assay of simple routine biochemical parameters such as serum bilirubin may help in predicting the early progression of CKD and more so in diabetic CKD.

Comparison of Serum Zinc Level Between Neonates With Jaundice and Healthy Neonates

Background: Neonatal jaundice is the most common cause of hospitalization in the first month of life. Factors that reportedly affect the severity of neonatal jaundice include: maternal, prenatal and neonatal factors as well as environmental factors (such as zinc). Animal study demonstrated a decrease in serum bilirubin level after zinc treatment in hyperbilirubinemic rats. Objectives: The current study aimed to investigate serum zinc level in the neonates with idiopatic jaundice. Patients and Methods: A case-control study was undertaken from 2008 to 2010 on 263 neonates in a neonatal intensive care unit and obstetrics department in Ghaem hospital, Mashhad, Iran. Of the 263 infants, 114 and 149 neonates were in the control and the case groups, respectively. Infants with a gestational age of > 35 weeks or with idiopathic jaundice were included in the study. Exclusion criteria were as follows: neonates with sepsis or any congenital abnormalities or with glucose-6-phosphate dehydrogenase (G-6PD) deficiency, ABO and RH incompatibility. Serum levels of zinc and bilirubin were compared between the control (114 neonates without jaundice) and case (149 neonates with jaundice) groups using atomic absorption spectrometry. The maternal and neonatal information were recorded. Spearman correlation coefficient, chi-square and Mann-Whitney tests were employed to analyze the data by SPSS software. Results: The mean value of the zinc serum level was 1024.74 ± 245.17 μmol/L in the control group and 841.42 ± 211.99 μmol/L in the case group (P 0.05). Also, no significant correlation was observed between serum levels of Na, blood urea nitrogen (BUN), creatinine (Cr), white blood cell (WBC), platelet, hematocrit (Hct) and zinc (P > 0.05). Conclusions: The level of serum zinc in the neonates with hyperbilirubinemia jaundice was lower than that of the ones without jaundice. It seems that zinc has a protective effect. However, more studies are needed for better decision making.

Active and Passive Smoking and Serum Total Bilirubin in a Rural Korean Population.

Serum bilirubin is an endogenous antioxidant biomarker and its low level is a potential risk factor for smoking related health disorders. This study investigated the association of cigarette smoke with serum total bilirubin among Koreans. Between 2006 and 2011, we examined 4899 Korean adults living in a rural community. After excluding 38 participants with serum bilirubin more than 2mg/dL, 75 participants who did not report their smoking status or who had liver or bile duct disorders, and 711 participants with liver enzymes exceeding the upper reference values, we performed a cross-sectional analysis on 4075 participants. Participants were classified into four groups: never-smokers without secondhand smoke exposure (SHSE), never-smokers with SHSE, former smokers, and active smokers. Serum total bilirubin concentration was measured using the enzyme method. Compared to never-smokers without SHSE, never-smokers with SHSE (β = -0.025 mg/dL), former smokers (β = -0.049 mg/dL), and active smokers (β = -0.149 mg/dL) had significantly lower serum bilirubin even after adjusting for demographic factors, study year, alanine aminotransferase, gamma-glutamyl transferase, hemoglobin, lifestyle factors, and chronic diseases. A sex-stratified analysis indicated that for men, former smokers and active smokers were significantly associated with having lower bilirubin when compared to never-smokers without SHSE. However, for women, never-smokers with SHSE and active smokers were significantly associated with having lower bilirubin when compared to never-smokers without SHSE. Our findings suggest that both active and passive cigarette smoking are associated with low serum bilirubin among Korean adults. Our results suggest that not only active smoking but also passive smoking including SHSE can have an influence on decreasing serum bilirubin levels. With this different point of view, our study supports efforts to create smoke-free environments in order to foster more favorable serum bilirubin profiles, which may improve endothelial function and reduce the risk of cardiovascular disease.

3:48 PM, Abstract No. 69 - Percutaneous biliary drainage catheter insertion in advanced hepatic metastatic disease

Patients with extensive metastatic hepatic tumor burden may be questionable candidates for percutaneous transhepatic biliary drainage (PBD) insertion due to concern for traversing tumor, a presumed dismal prognosis, compromised hepatic function as a contributor to hyperbilirubinemia, and multifocality of biliary ductal obstruction. The purpose of this study was to analyze outcomes of percutaneous biliary drainage (PBD) catheters in patients with advanced hepatic metastatic disease. Retrospective review of our procedural database was performed to identify patients undergoing PBD catheter insertion for the indication of hyperbilirubinemia and imaging-confirmed biliary dilation in the setting of severe multifocal hepatic metastatic disease (greater than 20% volume replacement) over a 7.5 year period. A total of 44 patients (24 males, mean age 57.4 years, range 34-80 years) were included for analysis. Periprocedural cross-sectional imaging was used to assess hepatic metastatic disease burden and location of PBD catheters. Complications, serum alkaline phosphatase (AP), and total bilirubin (TB) values were also investigated. PBD insertion was performed in 44 patients with severe hepatic metastatic disease burden. Colorectal (n=16) and pancreatic metastases (n=9) were most common. The serum total bilirubin decreased by at least 10% in 68% of patients. Of these patients, the mean decrease in bilirubin levels was 4.5±2.7mg/dL (42%±20%). Only 6% demonstrated normalization of bilirubin levels (less than 2 mg/dL). The median survival was 29 days (95% CI 15-43 days). Of 14 patients with a post-PBD insertion CT scan, in 11 patients (79%), the PBD traversed tumoral tissue prior to entering the biliary tree. Two patients required blood transfusions due to periprocedural blood loss without need for additional interventions. One patient re-presented with persistent pericatheter leakage. While the majority of patients demonstrated decreased serum bilirubin levels, normalization was rare and prognosis is dismal. PBD catheter traversal of hepatic tumors demonstrated a low incidence of significant hemorrhage or pericatheter leakage.

Investigation on Malondialdehyde, S100B, and Advanced Oxidation Protein Product Levels in Significant Hyperbilirubinemia and the Effect of Intensive Phototherapy on these Parameters

The parameters of oxidative stress [advanced oxidation protein products (AOPPs), malondialdehyde (MDA), and S100B] and the effect of intensive phototherapy (PT) on these parameters have not been studied extensively in newborns with significant hyperbilirubinemia (SH). We aimed to measure the levels of MDA, S100B, and AOPPs in newborns with SH, and to compare newborns with healthy control newborns without hyperbilirubinemia on the basis of these parameters of oxidative stress. In addition, we investigated the effect of intensive PT on these parameters during the treatment of SH and report our findings for the first time in the literature. The study was performed in newborns (n=62) who underwent intensive PT because of SH. Newborns without jaundice constituted the control group (n=30). Both groups were compared with respect to demographic characteristics and biochemical (laboratory) parameters including MDA, AOPPs, and S100B. MDA, AOPPs, and S100B were also compared before and after intensive PT in the PT group. In the study group, a correlation analysis of demographic characteristics; MDA, AOPP, and S100B values; and changes occurring in MDA, AOPPs, and S100B values due to the effect of intensive PT was performed. Serum total bilirubin, S100B, and MDA levels in the PT group before performing PT were significantly higher than those in the control group. In newborns receiving PT serum total bilirubin, MDA and AOPP levels decreased significantly after intensive PT. In correlation analysis, a statistically significant negative correlation was found only between the amount of bilirubin decrease with PT and AOPP levels after PT in the study group. Whether the significant decrease in MDA levels, which was higher prior to PT, is due to the decrease in serum bilirubin levels or due to the effect of intensive PT itself remains to be determined in further studies. The decrease in AOPP levels after PT implies that intensive PT has protective effects on oxidative stress.