Higher Serum Total Bilirubin Research Articles

Pulmonary Complications Following Adult Liver Transplantation

Purpose Pulmonary complications frequently occur after liver transplantation, but the risk factors associated with them have not been fully determined. We therefore sought to identify risk factors for pulmonary complications among adult liver transplant recipients. Methods We retrospectively reviewed the medical records of 128 consecutive adult patients who underwent 131 liver transplantations during 2001. We evaluated the incidence, time of onset, and outcome of radiographically determined pulmonary complications, as well as the factors predictive of infectious complications. Results Postoperative chest roentgenograms detected 68 cases of pulmonary complications, including pleural effusion ( n = 50), atelectasis ( n = 6), pneumonia ( n = 6), pulmonary edema ( n = 5), and acute respiratory distress syndrome associated with pneumonia ( n = 1). Of the seven patients with pneumonia, five died. On univariate analysis the risk factors predictive for pneumonia were high serum creatinine and total bilirubin, hemodialysis at the time of occurrence, and history of acute rejection and on multivariate analysis increased total bilirubin and history of acute rejection. Pulmonary complications were dependent on the medical condition at the time of occurrence rather than on the preoperative condition. Conclusions Although the incidence of pneumonia in liver recipients was relatively low, the mortality rate in patients who developed this complication was high. High-risk patients undergoing liver transplantation thus require early diagnosis and intensive treatment to diminish the morbidity and mortality associated with pulmonary complications.

Outcomes among newborns with total serum Bilirubin levels of 25 mg per deciliter or more

. Newman, T.B., Liljestrand, P., Jeremy, R.J., Ferriero, D.M., Wu, Y.W., Hudes, E.S., Escobar, G.J. , ( 2006 ) , 354 , 1889 – 1900 . Background The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined.Methods We identified 140 infants with neonatal total serum bilirubin levels of at least 25 mg per deciliter (428 µmol per litre) and 419 randomly selected controls from a cohort of 106 627 term and near‐term infants born from 1995 to 1998 in Kaiser Permanente hospitals in northern California. Data on outcomes were obtained from electronic records, interviews, responses to questionnaires and neurodevelopmental evaluations that had been performed in a blinded fashion.Results Peak bilirubin levels were between 25 and 29.9 mg per deciliter (511 µmol per litre) in 130 of the newborns with hyperbilirubinemia and 30 mg per deciliter (513 µmol per litre) or more in 10 newborns; treatment involved phototherapy in 136 cases and exchange transfusion in five. Follow‐up data to the age of at least 2 years were available for 132 of 140 children with a history of hyperbilirubinemia (94%) and 372 of 419 controls (89%) and included formal evaluation at a mean (±SD) age of 5.1 ± 0.12 years for 82 children (59%) and 168 children (40%) respectively. There were no cases of kernicterus. Neither crude nor adjusted scores on cognitive tests differed significantly between the two groups; on most tests, 95% confidence intervals excluded a 3‐point (0.2 SD) decrease in adjusted scores in the hyperbilirubinemia group. There was no significant difference between groups in the proportion of children with abnormal neurologic findings on physical examination or with documented diagnoses of neurologic abnormalities. Fourteen of the children with hyperbilirubinemia (17%) had ‘questionable’ or abnormal findings on neurologic examination, as compared with 48 controls (29%; P = 0.05; adjusted odds ratio, 0.47; 95% confidence interval, 0.23–0.98; P = 0.04). The frequencies of parental concern and reported behavioural problems also were not significantly different between the two groups. Within the hyperbilirubinemia group, those with positive direct antiglobulin tests had lower scores on cognitive testing but not more neurologic or behavioural problems.Conclusions When treated with phototherapy or exchange transfusion, total serum bilirubin levels in the range included in this study were not associated with adverse neurodevelopmental outcomes in infants born at or near term.

Streptococcus suis infection: a series of 41 cases from Chiang Mai University Hospital

The objectives of this study were (1) to assess the clinical manifestations, treatment, and outcome of Streptococcus suis infection in adult patients in northern Thailand, (2) to evaluate the anti-microbial sensitivity pattern and (3) to determine the predicting factors of high mortality rate. A retrospective study was conducted at Chiang Mai University Hospital from May 2000 to December 2002. Anti-microbial susceptibility test was performed by agar disk diffusion and the minimal inhibitory concentration (MIC) by E-test. Forty-one patients (32 men and nine women, mean age 51 years) with S. suis infection were identified. Three patients had a history of exposure to pig or pork and one patient had a history of raw beef consumption. Clinical manifestations included infective endocarditis, meningitis, sepsis, spondylodiscitis, and endophthalmitis in 16, 13, 10, 1, and 1 patients, respectively. The overall mortality rate was 19.5%. On univariate analysis, low serum albumin, high serum total bilirubin, low platelet, and rapid onset of illness were significantly correlated with high mortality rate. All isolates were sensitive to penicillin (mean MIC90=0.027 microg/ml). S. suis infection is not uncommon in northern Thailand. High suspicion and early detection are important and could lead to the successful treatment.

Outcomes among Newborns with Total Serum Bilirubin Levels of 25 mg per Deciliter or More

The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined. We identified 140 infants with neonatal total serum bilirubin levels of at least 25 mg per deciliter (428 micromol per liter) and 419 randomly selected controls from a cohort of 106,627 term and near-term infants born from 1995 through 1998 in Kaiser Permanente hospitals in northern California. Data on outcomes were obtained from electronic records, interviews, responses to questionnaires, and neurodevelopmental evaluations that had been performed in a blinded fashion. Peak bilirubin levels were between 25 and 29.9 mg per deciliter (511 micromol per liter) in 130 of the newborns with hyperbilirubinemia and 30 mg per deciliter (513 micromol per liter) or more in 10 newborns; treatment involved phototherapy in 136 cases and exchange transfusion in 5. Follow-up data to the age of at least two years were available for 132 of 140 children with a history of hyperbilirubinemia (94 percent) and 372 of 419 controls (89 percent) and included formal evaluation at a mean (+/-SD) age of 5.1+/-0.12 years for 82 children (59 percent) and 168 children (40 percent), respectively. There were no cases of kernicterus. Neither crude nor adjusted scores on cognitive tests differed significantly between the two groups; on most tests, 95 percent confidence intervals excluded a 3-point (0.2 SD) decrease in adjusted scores in the hyperbilirubinemia group. There was no significant difference between groups in the proportion of children with abnormal neurologic findings on physical examination or with documented diagnoses of neurologic abnormalities. Fourteen of the children with hyperbilirubinemia (17 percent) had "questionable" or abnormal findings on neurologic examination, as compared with 48 controls (29 percent; P=0.05; adjusted odds ratio, 0.47; 95 percent confidence interval, 0.23 to 0.98; P=0.04). The frequencies of parental concern and reported behavioral problems also were not significantly different between the two groups. Within the hyperbilirubinemia group, those with positive direct antiglobulin tests had lower scores on cognitive testing but not more neurologic or behavioral problems. When treated with phototherapy or exchange transfusion, total serum bilirubin levels in the range included in this study were not associated with adverse neurodevelopmental outcomes in infants born at or near term.

Factors related to post‐treatment relapse in chronic hepatitis B patients who lost HBeAg after lamivudine therapy

It is uncertain if a patient's lamivudine response after HBeAg loss is durable. In Korean chronic hepatitis B patients, the relapse rate is high after termination of lamivudine therapy for patients with HBeAg loss. We evaluated the factors related to relapse in chronic hepatitis B patients with HBeAg loss after lamivudine therapy. A total of 132 chronic hepatitis B patients, who initially had HBeAg and did not have decompensated features, were analyzed in this study. These patients lost the HBeAg after lamivudine therapy and then their therapy was stopped. Post-treatment serum alanine aminotransferase (ALT), HBeAg, anti-HBe and hepatitis B virus (HBV) DNA were monitored until relapse. Seventy-five patients relapsed (cumulative relapse rate: 56% at 6 months). Upon univariate analysis, the factors of age, serum total bilirubin, presence of anti-HBe after HBeAg loss, and the duration of additional lamivudine therapy after HBeAg loss were associated with relapse. Upon multivariate analysis, older age, a higher serum total bilirubin and the shorter duration of additional lamivudine therapy were significant risk factors for relapse. Patterns of relapse were the re-elevation of ALT, re-emergence of HBV DNA (69 patients) and reappearance of HBeAg (55 patients). To prevent relapse in patients with chronic hepatitis B infection after lamivudine therapy, age and serum bilirubin level of patients as well as a prolonged duration of additional lamivudine therapy should be considered.

Infants with bilirubin levels of 30 mg/dL or more in a large managed care organization.

To describe the incidence, etiology, treatment, and outcome of newborns with total serum bilirubin (TSB) levels >or=30 mg/dL (513 micro mol/L). Population-based case series. Eleven Northern California Kaiser Permanente Medical Care Program hospitals and 1 affiliated hospital. Eleven infants with TSB levels of >or=30 mg/dL in the first 30 days after birth, identified using computer databases from a cohort of 111,009 infants born 1995-1998. Clinical data from the birth hospitalization, rehospitalization, and outpatient visits in all infants; psychometric testing at age 5 (N = 3), neurologic examinations by child neurologists at age 5 (N = 3), or primary care providers (N = 7; mean age: 2.2 years); Parent Evaluation of Developmental Status (N = 8; mean age: 4.2 years). Maximum TSB levels of the 11 infants ranged from 30.7 to 45.5 mg/dL (525 micro mol/L to 778 micro mol/L; mean: 34.9 mg/dL [597 micro mol/L]). Four were born at 35 to 36 weeks gestation, and 7 were exclusively breastfed. Two had apparent isoimmunization; the etiology for the other 9 remained obscure, although only 4 were tested for glucose-6-phosphate dehydrogenase deficiency and 1 was bacteremic. None had acute neurologic symptoms. All received phototherapy and 5 received exchange transfusions. One infant died of sudden infant death syndrome; there was no kernicterus at autopsy. Two were lost to follow-up but were neurologically normal when last seen for checkups at 18 and 43 months. One child was receiving speech therapy at age 3. There were no significant parental concerns or abnormalities in the other children. In this setting, TSB levels >or=30 mg/dL were rare and generally unaccompanied by acute symptoms. Although we did not observe serious neurodevelopmental sequelae in this small sample, additional studies are required to quantify the known, significant risk of kernicterus in infants with very high TSB levels.

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.

Newborns with hyperbilirubinemia: usefulness of brain stem auditory response evaluation

We describe brain stem auditory evoked potentials (BAEP) obtained in 48 full-term newborns (20 boys, 28 girls) presenting with high serum total bilirubin concentration (from 238 to 442 mM) without Rhesus of group A, B, O factors incompatibility. Recordings were performed on the 3rd day of life and repeated 5-7 days post-appropriate therapy with photostimulation and exchange transfusion (when bilirubin concentration had decreased below 136 mM). Supplementary recordings were performed 3, 6 and 12 weeks later in order to assess test-retest reliability of components. Mean values of BAEP latencies were compared with those obtained in 40 age-matched control subjects using the same recording procedures. At first recording session (on the 3rd day), latencies of waves III and V obtained in hyperbilirubinemic patients were significantly increased as compared with records in control subjects. Recordings performed 5 to 7 days post-therapy and during subsequent recording sessions showed no significant differences between patients and control groups. Serial neuropsychological evaluations obtained over a 3-year follow-up showed no subsequent neurodevelopmental abnormality for all patients. These findings suggest that hyperbilirubinemia can alter central neurotransmission in auditory brain stem pathways, but this modification is only transient.

マラリア患者の黄だんについて

The serum bilirubin of malaria patients was investigated in an effort to show that jaundice occuring in malaria patients differs from hepatocellular (hepatitis) and obstructive jaundice.1. The incidence of abnormally high serum total bilirubin (≥ 1.1 mg/dl) was more frequent in cases of falciparum than in vivax and ovale malaria patients put together (71% vs 49%, p <0.01). The maximum value of a falciparum malaria patient was 42.3 mg/dl.The following data were obtained concerning falciparum malaria : 2. All 14 patients showing ≥ 5.1 mg/dl of serum total bilirubin were moribund, and 7 of them died.3. A positive correlation was noted between the maximum parasite count and serum total bilirubin (p <0.01).4. The mean values of total, direct and indirect bilirubin and the ratio of direct / total (d/t) bilirubin were 9.4, 5.4, 3.9 mg/dl and 0.5, respectively. There were no significant differences in the mean and variance of direct and indirect bilirubin.5. A positive correlation was found between serum total bilirubin and d/t ratio (p < 0.02).6. The mean values of SGOT, SGPT, γ-GTP and LDH were 70, 132, 74 and 1, 110, respectively. The maximum value of LDH was 15, 140. The above data may prove to be helpful in differentiating jaundice in malaria patients from hepatocellular and obstructive jaundice.