Higher Serum Total Bilirubin Levels Research Articles

Association of Serum Bilirubin Levels with Macro- and Microvascular Complications in Chinese People with Type 2 Diabetes Mellitus: New Insight on Gender Differences.

Previous studies suggested protective effects of bilirubin against cardiovascular disease, with a possible gender difference. However, the relationship between serum total bilirubin (TBIL) with diabetic macro- and microvascular complications remains unknown. We aimed to examine the association of macro- and microvascular complications with serum TBIL levels. Serum TBIL was measured in 648 patients with T2DM. Demographic and clinical data were obtained from the inpatient medical record system. Serum TBIL was measured with an automatic biochemistry analyzer according to routine protocols. Parameters of vascular complications, including ankle-brachial index, carotid intima-media thickness, estimated glomerular filtration rate and the urinary albumin to creatinine ratio, were measured and calculated. The association between TBIL and diabetic macro- and microvascular complications was analyzed. In multivariable logistic regression, after adjustment for age, sex, body mass index and diabetic duration, higher serum TBIL levels were significantly associated with decreased odds of microalbuminuria (OR = 0.31, [95% CI] 0.16-0.61, P = 0.003) and chronic kidney disease (OR = 0.19, [95% CI] 0.09-0.41, P < 0.001). These associations were only found in male but not in female patients. However, no significant relationship was found between TBIL and peripheral arterial disease or carotid hypertrophy. Our findings suggest that physiological higher TBIL level might be a protective factor for diabetic microvascular complications.

Postcardiotomy Extracorporeal Membrane Oxygenation Support in Patients with Congenital Heart Disease.

BackgroundThis study investigated mortality and morbidity in patients requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) support after operations for congenital heart disease (CHD).MethodsCHD patients requiring postoperative ECMO support between May 2011 and May 2021 were retrospectively reviewed. Patients were divided into non-survivors and survivors to hospital discharge. Survival outcomes and associations of various factors with in-hospital death were analyzed.ResultsFifty patients required postoperative ECMO support. Patients’ median age and weight at the time of ECMO insertion were 1.85 months (interquartile range [IQR], 0.23–14.5 months) and 3.84 kg (IQR, 3.08–7.88 kg), respectively. Twenty-nine patients (58%) were male. The median duration of ECMO support was 6 days (IQR, 3–12 days). Twenty-nine patients (58%) died on ECMO support or after ECMO weaning, and 21 (42%) survived to hospital discharge. Postoperative complications included renal failure (n=33, 66%), bleeding (n=11, 22%), and sepsis (n=15, 30%). Prolonged ECMO support (p=0.017), renal failure (p=0.005), continuous renal replacement therapy (CRRT) application (p=0.001), sepsis (p=0.012), bleeding (p=0.032), and high serum lactate (p=0.002) and total bilirubin (p=0.017) levels during ECMO support were associated with higher mortality risk in a univariate analysis. A multivariable analysis identified CRRT application (p=0.013) and a high serum total bilirubin level (p=0.001) as independent risk factors for death.ConclusionPostcardiotomy ECMO should be considered as an important therapeutic modality for patients unresponsive to conventional management. ECMO implementation strategies and management in appropriate patients without severe complications, particularly renal failure and/or liver failure, are crucial for achieving positive outcomes.

Effect of herbal formulation intake on health indices in albino Wistar rat model.

Dyslipidemia management activity of ginger‐, garlic‐, and lemon‐based herbal mixture was tested as paste and herbal extract in hypercholesterolemic adult male albino rats. Atherogenic diet‐induced hypercholesterolemia in rats was treated by supplementing the diet with 2.5% herbal paste (4.2 g/kg b.w.) or 2.5 ml oral gavage (20 ml/kg b.w.) of liquid herbal extract daily for 42 days. Hematological and serological outcomes of herbal formulation feeding were compared with the cholesterol‐fed positive control and normal control. The results suggest the significant (p < .05) inhibitory properties of herbal paste and liquid extracts against dyslipidemia showing 31%–37%, 62%–68%, and 40%–56% lower levels of total cholesterol, triglycerides (TGs), and low‐density lipoprotein cholesterol (LDL‐C), respectively. Treating cholesterol‐fed animals with herbal paste and extract significantly (p < .05) increased total protein (5–5.5 g/dl) and serum albumin (3.7–4.2 g/dl) concentration as compared to the normal control. Contrary to significant hypocholesterolemic activity, higher serum total bilirubin levels, that is, 0.70 mg/dl, were observed in rats subchronically exposed to herbal paste and liquid extracts. Nonsignificant (p > .05) impact of herbal formula feeding was observed on hematological indices except lymphocyte counts, that is, 93% in rats fed on herbal paste. The results validate conventional hypocholesterolemic claims associated with ginger‐, garlic‐, and lemon‐based herbal formulations; however, deeper insight into their dose‐dependent response in hypercholesterolemia is necessitated to rule out the toxicological impact on the consumer.

Prognostic impact of 8-hydroxy-deoxyguanosine and its repair enzyme 8-hydroxy-deoxyguanosine DNA glycosylase in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) has a poor prognosis in the setting of chronic inflammation and fibrosis, both of which promote nuclear DNA oxidative damage. 8-hydroxy-deoxyguanosine (8-OHdG) DNA glycosylase (OGG1) enhances the repair of 8-OHdG, which is the primary oxidative stress-induced mutation that leads to malignant alterations. This study aims to clarify the relationships between oxidative stress-induced factors and HCC progression. The clinicopathological factors were compared with immunohistochemistry OGG1 and 8-OHdG expressions in 86 resected HCC specimens. High 8-OHdG expression was associated with high serum aspartate transaminase and total bilirubin levels, as well as a low platelet count, compared with low 8-OHdG expression. Histological liver cirrhosis and poor differentiation were more frequent in patients with high 8-OHdG expression than in those with low 8-OHdG expression. The 8-OHdG was negatively correlated with OGG1 expression in HCC patients. Therefore, we classified the patients into two groups, low OGG1/high 8-OHdG group and the other group. The patients with low OGG1/high 8-OHdG expressions had worse prognosis than those with the other expressions. Our results showed that low OGG1/high 8-OHdG expressions in nuclei influence HCC patient outcomes. Evaluating the patterns of OGG1 and 8-OHdG expressions might provide pivotal prognostic biomarkers in patients with HCC.

Clinical features, risk factors, and prognostic markers of drug-induced liver injury in patients with stevens-johnson syndrome/toxic epidermal necrolysis

Background:The liver and skin are the most common organs involved in Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Drug reactions rarely affect both organs concurrently. The clinical features, risk factors, and prognostic markers of drug-induced liver injury (DILI) in patients with SJS/TEN are not well studied.Materials and Methods:The clinical features, risk factors, and prognostic markers of DILI in patients with SJS/TEN hospitalized at the dermatology department of our hospital from January 2009 to December 2018 were retrospectively analyzed.Results:A total of 298 patients with SJS/TEN were enrolled in this study. Of them, 40 had liver injury and the rest served as control. Causative drugs mainly included antipodagrics (xanthine oxidase inhibitors occupying 100% among antipodagrics), anticonvulsants (dibenzazepine occupying 76.92% among anticonvulsants), and traditional Chinese medicines. There was a statistically significant difference between the patients with liver injury and the control group in the history of liver disease, diabetes, and hyperlipidemia (P < 0.05). Nine of the 40 patients with liver injury died. High serum total bilirubin and creatinine levels were significantly associated with poor prognosis of DILI in patients with SJS/TEN (P < 0.05).Conclusion:DILI usually occurs in patients with SJS/TEN. Pre-existing liver disease, diabetes, and hyperlipidemia are independent risk factors for DILI in patients with SJS/TEN. High serum total bilirubin and creatinine levels may be useful prognostic markers for DILI in patients with SJS/TEN.

Assessment of prognosis in immunoglobulin light chain amyloidosis patients with severe heart failure: a predictive value of right ventricular function.

Although the benefit of updated therapeutic regimens, including bortezomib, on the survival of immunoglobulin light chain (AL) amyloidosis patients with heart failure (HF) has been reported, predictors of mortality in the patients treated with the updated therapy remain unclear. We retrospectively enrolled AL amyloidosis patients who had severe HF at the time of diagnosis and received the updated therapy, including bortezomib (n = 19, 61 ± 6years old, 68% male). Severe HF was defined as the presence of both NYHA functional class III or IV and BNP > 200pg/ml or NT-pro-BNP > 900pg/ml. One-year mortality rate during follow-up after commencement of the treatment was 37%. Left ventricular morphological parameters and indexes of left ventricular diastolic function on admission were similar in the non-survivors and survivors. However, non-survivors had higher incidences of atrial fibrillation and ventricular tachycardia, higher serum total bilirubin levels (1.34 ± 0.55 vs. 0.61 ± 0.29mg/dl), higher right atrial volume index (RAVI 49.7 ± 29.9 vs. 27.3 ± 6.8ml/m2), lower tricuspid annular peak velocities during systole (RVs' 8.0 ± 1.8 vs. 11.6 ± 3.7cm/sec) and late diastole (RVa' 3.4 ± 0.9 vs. 11.4 ± 5.3cm/sec), and larger inferior vena cava dimension (22.7 ± 6.4 vs. 16.3 ± 4.9mm) than those in survivors. Kaplan-Meier curve analyses showed that larger RAVI and lower RVs' and RVa', but not left ventricular systolic/diastolic dysfunction, predicted higher mortality during 1-year follow-up. The present results suggest that the presence of right-sided heart abnormality on admission is associated with high 1-year mortality in AL amyloidosis patients with severe HF under the updated therapeutic regimens.

Endoscopic treatment or balloon-occluded retrograde transvenous obliteration is safe for patients with esophageal/gastric varices in Child-Pugh class C end-stage liver cirrhosis.

Background/AimsThere is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients.MethodsThe study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment.ResultsThe OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL).ConclusionsThe study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.

Low serum bilirubin levels associated with subclinical atherosclerosis in patients with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) is a chronic, progressive disease that can cause cardiovascular complications and atherosclerosis. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with OSA.MethodsWe enrolled 84 consecutive patients with OSA. The patients underwent ultrasonography, polysomnography, and echocardiography. Blood samples were obtained from all of the subjects, which were used for biochemical comparisons. The patients were divided into groups according to cIMT values (<0.9 vs. >0.9 mm).ResultsThe patient population consisted of 84 OSA patients (mean age: 54.2 + 8.0 years, 62.9% male). The OSA patients with cIMT ≥0.9 had significantly elevated high-sensitive C-reactive protein (hsCRP), Oxygen desaturation index, apnea–hypopnea index (AHI), and significantly lower total and indirect bilirubin levels. Multivariate regression analyses revealed that total bilirubin, hsCRP, and AHI were the independent predictors of subclinical atherosclerosis. There was a negative correlation between total bilirubin and cIMT.ConclusionsThis study showed that high hsCRP and low serum total bilirubin levels could be paving the way for the development of subclinical atherosclerosis. Simple measures such as total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with OSA.

Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury.

Aims The aim of this study was to assess the prognostic value of the serum total bilirubin (TBIL) level in pediatric patients with sepsis-associated liver injury (SALI). Methods We performed a retrospective study of patients with SALI admitted to the pediatric intensive care unit (PICU) in Shanghai Children's Hospital between December 2012 and December 2015. Serum TBIL concentration was determined within 72 h after PICU admission. Results Seventy-two patients with SALI were included in this study. The overall mortality rate was 36.1% (26/72). The serum levels of TBIL of patients were significantly higher in the nonsurvivor group than the survivor group. Cox regression analysis indicated that the elevated serum TBIL level within 72 hours after admission was an independent risk factor of mortality in patients with SALI. Furthermore, the area under the receiver-operating characteristic (ROC) curve (AUC) for TBIL was 0.736 (95% confidence interval (CI): 0.614–0.858, P=0.001), in which the optimal cut-off value was 64.5 μmol/L. The combined index named “TBIL” and “TBA” showed an AUC of 0.745 (0.626–0.865) for predicting the prognosis in patients with SALI. In addition, the Kaplan–Meier curve indicated that the 28-day survival rate was significantly lower in patients with higher serum TBIL levels (≥64.5 μmol/L) or higher value of TBIL and TBA (≥−0.8902). Conclusions Elevated serum TBIL level is associated with poor outcomes in pediatric SALI.

Serum total bilirubin levels and disease severity in patients with stable coronary artery disease.

Serum total bilirubin (STB), a protective cardiovascular factor, was retrospectively investigated to determine the relationship between STB levels and the severity of disease in Chinese patients with stable coronary artery disease (CAD). Atotal of 347 eligible patients presenting to our department from December 2007 to December 2012 were divided into tertiles according to their Syntax scores (low, moderate, and high). To clarify the association between STB levels and major adverse cardiovascular events (MACE), all patients were divided into two groups according to the median baseline STB (greater than or less than 13.2μmol/l), which was measured after at least 12-h fast. All participants were followed for amean of 37.1months for MACE, including all-cause death, recurrent nonfatal myocardial infarction, and recurrent percutaneous coronary intervention. The STB levels were significantly lower in the high Syntax score group than those of the other groups and were negatively correlated with the Syntax score and number of diseased vessels. Follow-up data showed ahigher incidence of MACE in the low STB group compared with the high STB group. Elevated STB levels predict the long-term prognosis of patients with stable angina pectoris. Finally, Kaplan-Meier analysis showed asignificantly higher event-free survival rate in the patients with high STB levels than those in the low STB group. STB levels were independently associated with the severity of disease in patients with stable CAD. Elevated STB is associated with cardiovascular events and may be useful as abiomarker of the severity and prognosis of stable CAD.

Variables determining the development of colistin-associated renal impairment.

The aim of this study was to identify the predictors of acute renal injury associated with colistin treatment. The patients who received treatment with colistin for more than 3 days were included in this retrospective cohort study. Acute renal injury was defined by the RIFLE (Risk Injury Failure Loss End stage renal disease) criteria. Patients whose serum creatinine levels increased at least 1.5-fold compared with baseline value were considered as cases with renal injury. The independent variables determining the development of acute renal injury were investigated by survival analysis. A total of 112 cases [67 (59.8 %) were male, median age 64 (range: 18-93) years] were included in the study. Acute renal injury occurred in 66 (58.9 %) patients. Renal injury developed in first 7 days of the colistin therapy in 52 (78.8 %) cases and at day 8-23 in 14 (21.2 %) cases. On the day with highest levels of creatinine, 25 (22.3 %), 17 (15.2 %), and 33 (29.5 %) cases were in 'Risk', 'Injury', and 'Failure' group, respectively, according to RIFLE criteria. We identified three independent risk factors predicting acute colistin-induced renal injury: advanced age, low serum albumin levels, and high serum total bilirubin levels [odds ratio (confidence interval) = 1.022 (1.006-1.037), 0.643 (0.415-0.994), and 1.129 (1.014-1.257), respectively]. The advanced age, low serum albumin levels, and high serum total bilirubin levels are independent risk factors for colistin-induced nephrotoxicity.

Serum unbound bilirubin as a predictor for clinical kernicterus in extremely low birth weight infants at a late age in the neonatal intensive care unit.

This study aimed to evaluate peak serum total bilirubin (TB) and unbound bilirubin (UB) levels in preterm infants with clinical kernicterus (KI) who were diagnosed by clinical findings during infancy. For this multicenter retrospective study, 18 Japanese extremely low birth weight (ELBW) infants with clinical KI were included. Clinical KI was diagnosed based on the presence of motor developmental impairment with/without athetosis, and abnormal magnetic resonance imaging or brainstem auditory evoked potential findings during infancy. High and low TB or UB levels were defined as serum TB levels ⩾ and <15 mg/dL or serum UB levels ⩾ and <0.8 μg/dL, respectively. The clinical characteristics of KI preterm infants were analyzed. The proportion of infants with high or low serum TB levels and with high or low serum UB levels was then investigated. Sensitivity and specificity were calculated. In 18 KI infants, the median age when serum TB levels peaked was 28 days after birth. In eight KI infants with low serum TB levels, 88% of them had high serum UB levels. For comparison of the number of infants who had high or low serum TB and UB levels, the sensitivity was 90% and specificity was 13%. Serum TB and UB levels peak at a later age than expected. Chronic serum UB monitoring may be helpful for identifying ELBW infants at risk for developing KI, even when they do not have high serum TB levels.

Sonic hedgehog (SHH) and glioblastoma-2 (Gli-2) expressions are associated with poor jaundice-free survival in biliary atresia

Background/PurposeBiliary atresia (BA) causes biliary obstruction in neonates. Although the Kasai operation can successfully treat certain BA cases, many patients exhibit recurrent jaundice and secondary biliary cirrhosis requiring liver transplantation. Consequently, studies of the prognostic factors of the Kasai operation are needed. Accordingly, sonic hedgehog (SHH) pathway expression at the extrahepatic bile duct (EHBD), an important bile duct repair mechanism, will be investigated via immunohistochemistry in patients with BA to examine the association with post-Kasai operation prognosis. MethodsFifty-seven EHBD specimens were obtained during Kasai operations from 1992 to 2009. The SHH, patched (PTCH), and glioblastoma-2 (Gli-2) immunohistochemical staining results were analyzed quantitatively. ResultsOverall, 57.9% of patients had bile flow normalization after the Kasai operation; 43.1% did not. High preoperative serum total bilirubin, direct bilirubin, and aspartate aminotransferase levels were associated with sustained jaundice post-Kasai operation, as was an age ≥65days at the time of surgery (all p<0.05). High Gli-2 and SHH expression rates were significantly associated with early post-Kasai operation jaundice relapse. ConclusionStrong Gli-2 and SHH expression in the EHBD might be a poor prognostic factor in Kasai operation-treated patients with BA.

Associations between serum total bilirubin levels and functional dependence in the elderly

Many studies support the role of bilirubin as a cytoprotector in chronic inflammatory diseases, such as stroke and atherosclerosis. To investigate the relationship between serum total bilirubin levels and functional dependence in older adults. Data from the National Health and Nutrition Examination Survey (1999-2002) pertaining to 2235 old adults were analysed. All participants had given a household interview, providing information of five major domains on self-reported functional status (activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility and general physical activities), had completed serum total bilirubin measurement, and a questionnaire regarding personal health. Poor performance was defined as experiencing difficulty with one or more items in a given domain. Functional dependence was defined as having three or more poor performances in the five major domains. Multiple logistic regression was performed together with quartile-based stratified odds ratio (OR) comparison and trend tests. The OR of functional dependence for each standard deviation increment in the serum total bilirubin level was 0.56 (P = 0.002). After additional adjustment, the inverse association remained essentially unchanged. In quartile-based analysis, participants with higher quartiles of serum total bilirubin tended to have lower ORs of functional dependence. The trends of lower likelihood of functional dependence across increasing quartiles of the serum total bilirubin level were statistically significant (P < 0.05 for all trends). Higher serum total bilirubin levels were associated with lower likelihood of functional dependence in older adults.

Prognostic Value of Total Bilirubin in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Coronary Intervention

Previous studies have shown that the serum total bilirubin (TB) concentration was inversely related with stable coronary artery disease, diabetes mellitus, hypertension, and metabolic syndromes. The relation between TB levels and in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is not known. Data from 1,624 consecutive patients with STEMI who underwent primary PCI were evaluated. TB was measured after primary PCI, and the study population was divided into tertiles. The high TB group (n=450) was defined as a value in the upper third tertile (>0.9 mg/dl) and the low TB group (n= 1,174) as any value in the lower 2 tertiles (≤0.9 mg/dl). The in-hospital mortality rate was significantly greater in the high TB group than in the low TB group (4% vs 1.5%, p= 0.003). In the multivariate analyses, a significant association was noted between high TB levels and the adjusted risk of in-hospital cardiovascular mortality (odds ratio 3.24, 95% confidence interval 1.27 to 8.27, p= 0.014). In the receiver operating characteristic curve analysis, TB >0.90 mg/dl was identified as an effective cutpoint in patients with STEMI for in-hospital cardiovascular mortality (area under the curve 0.66, 95% confidence interval 0.55 to 0.76, p= 0.001). The mean follow-up period was 26.2 months. No differences wereseen in the long-term mortality rates between the 2 groups. In conclusion, high TBisindependently associated with in-hospital adverse outcomes in patients with STEMIwhoundergo primary PCI. However, no association was found with long-term mortality.

Serum γ‐Glutamyltransferase: Independent Predictor of Risk of Diabetes, Hypertension, Metabolic Syndrome, and Coronary Disease

Serum γ-glutamyltransferase (GGT) is associated with oxidative stress and hepatic steatosis. The extent to which its value in determining incident cardiometabolic risk (coronary heart disease (CHD), metabolic syndrome (MetS), hypertension and type 2 diabetes) is independent of obesity needs to be further explored in ethnicities. After appropriate exclusions, a cohort of 1,667 adults of a general population (age 52 ±11 years) was evaluated prospectively at 4 year's follow-up using partly Cox proportional hazard regressions. GGT activity was measured kinetically, and values were log-transformed for analyses. MetS was identified by Adult Treatment Panel-III criteria modified for male abdominal obesity. Median (interquartile range) GGT activity was 24.9 (17.0; 35.05) U/l in men, 17.0 (12.3; 24.0) U/l in women. In linear regression analysis, while smoking status was not associated, (male) sex, sex-dependent age, alcohol usage, BMI, fasting triglycerides and C-reactive protein (CRP) were significant independent determinants of circulating GGT. Each 1-s.d. increment in (= 0.53 ln GGT) GGT activity significantly predicted in each sex incident hypertension (hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10; 1.31)), and similarly MetS, after adjustment for age, alcohol usage, smoking status, BMI and menopause. Strongest independent association existed with diabetes (HR 1.3 (95% CI 1.1; 1.5)) whereas GGT activity tended to marginally predict CHD independent of total bilirubin but not of BMI. Higher serum total bilirubin levels were protective against CHD risk in women. We conclude that elevated serum GGT confers, additively to BMI, risk of hypertension, MetS, and type 2 diabetes but only mediates adiposity against CHD risk.

Predictors Of Poor Prognosis In Patients With Malignant Ascites: A Prospective Study

Malignant ascites is a manifestation of end stage events in a variety of cancers with significant morbidity and a poor prognosis.This study prospectively evaluated factors predicting poor prognosis in patients with malignant ascites. Clinico-pathologic data of patients with malignant ascites at our institution over a period of 18 months were prospectively analysed. Predictors of poor survival were evaluated and survival compared among different cancer groups. A total of 150 patients (96 females, 54 males) with median age of 63 (19-95) years were studied. The commonest cancer was ovarian. Liver metastases were significantly commoner in the gastrointestinal cancers (P=0.0001). Serial paracentesis was offered to 131, chemotherapy in 89, diuretics in 35, intraperitoneal monoclonal antibody in 6 and 7 patients had drainage at surgery. The median survival after the diagnosis of malignant ascites was 9.2 months. Ovarian cancer and female gender favour longer survival while poor performance status, low serum albumin/serum protein, liver metastases, high serum urea, creatinine and total bilirubin levels adversely affected survival. The independent prognostic factors for survival were poor performance status, cancer type, liver metastases, low serum albumin and high urea levels. The cancer type and performance status sig- nificantly influence the choice of treatment option.

Serum levels of γ-globulin and total bilirubin influence the prevalence of multiple extrahepatic complication in patients with hepatitis C virus infection

Patients with chronic hepatitis C virus (HCV) infection develop various extrahepatic complications. In this study, we analyzed as following. (1) The prevalence and interrelation of multiple extrahepatic manifestations. (2) Exact factors that are related to multiple extrahepatic manifestations. Consecutive autopsies of 261 cases with HCV infection that had undergone autopsy in 1988–1998 were enrolled. One hundred and forty consecutive patients who had gastro enteric carcinoma and underwent autopsy after death in our institution during the same period were used as controls. These 140 patients did not have hepatitis virus and chronic hepatitis or liver cirrhosis histologically. The prevalence of glomerulonephritis (GN), sialadenitis, thyroiditis, and idiopathic pulmonary fibrosis (IPF) was determined histologically. ‘Multiple extrahepatic complications’ was defined as the presence of two or more of the above four extrahepatic complications. Multiple logistic regression analyses of the risk for the multiple extrahepatic manifestations were performed. GN was present in 58.6% (153 cases), sialadenitis in 16.1% (42 cases), thyroiditis in 7.7% (20 cases), and IPF in 5% (13 cases) in cases of HCV infection. In addition, 37 out of 261 (14.2%) and seven (2.7%) cases had two and three extrahepatic complications, respectively. Multivariate analysis showed that multiple extrahepatic complications correlated with high serum γ-globulin levels (≥2.5 g/dl) and high serum total bilirubin levels (≥1.2 mg/dl) about 1 year before death. Moreover, about 70–80% of patients with sialadenitis, IPF, or thyroiditis had other extrahepatic manifestations. HCV-positive patients with high serum γ-globulin or high total bilirubin are at high risk of multiple extrahepatic complications.

Changes in portal vein hemodynamics after hepatic portoenterostomy in biliary atresia

Portal vein (PV) shrinkage sometimes eliminates the possibility of liver transplantation in biliary atresia patients after hepatic portoenterostomy. To determine the factors leading to PV shrinkage, we performed a serial sonographic study of the portal venous system in 21 children. Cross-sectional PV area and mean portal venous velocity (PVV) were reduced in patients with refractory cholangitis and those with gastroesophageal varices and cholangitis. Although the reduction in cross-sectional PV area was greater in patients with four-time laparotomy than single laparotomy, the mean PVV was not reduced by repeated laparotomy. Patients with varices were lower in age, weight, mean PVV, cross-sectional PV area for age, and had higher serum total bilirubin levels. In conclusion, refractory cholangitis is a significant factor in shrinking the PV. With active bile drainage, varices spontaneously regress, the PV increases in both caliber and total length per unit hepatic volume, and PVV normalizes. It is suggested that pulsed Doppler PV sonography can help to determine the optimal time for liver transplantation referral in biliary atresia patients with progressive cirrhosis.