Serum Direct Bilirubin Levels Research Articles

Optimizing growth and antioxidant function in heat-stressed broilers with vitamin C and betaine supplementation.

This study investigates the potential of vitamin C (VC) and/or betaine (Bet) to enhance growth performance, regulate serum metabolism, and bolster antioxidant function aiming to mitigate the impact of heat stress (HS) on broilers. Two hundred Ross 308 broilers at 28 days of age were randomly assigned to five groups. The control group, housed at 24 ± 1℃, was fed a basal diet. High-temperature treatment groups, housed at 32 ± 1℃, received a basal diet with 0 (HS group), 250mg/kg VC (HSVC group), 1000mg/kg Bet (HSBe group), and 250mg/kg VC + 1000mg/kg Bet (HSVCBe group). On day 42, assessments were made on growth performance, muscle quality, serum biochemistry, and antioxidant function. Results revealed that HS significantly lowered (P < 0.05) average daily feed intake (ADFI), the degree of redness (a*) in muscles, and serum total superoxide dismutase (T-SOD) level. It also reduced (P < 0.01) average daily gain (ADG), and serum total antioxidant capacity (T-AOC) level, while increasing (P < 0.05) shear force, serum direct bilirubin (D-BIL), uric acid (UA), and malondialdehyde (MDA) levels compared with the control group. Dietary supplementation of VC and Bet, either alone or in combination, significantly decreased shear force and serum UA level, while increasing ADG and serum T-AOC, T-SOD level compared with the HS group (P < 0.05). In conclusion, the addition of VC and/or Bet to the diet proves effective in enhancing the growth performance of HS-exposed broilers through the positive regulation of serum chemical metabolism and the alleviation of oxidative damage.

The Effected of Curcuma to Dysmenorrhea: A Systematic Review

Background: Dysmenorrhea or menstrual pain is a common health problem among reproduction women. The prevalence of dysmenorrhea was high in many countries including in Indonesia. Some previous studies showed that curcumin was effective reduced menstrual pain. Purpose: The aim of this study was to determine the effected of curcumin to dysmenorrhea. Method: This study used systematic review method with Randomize Control Trial (RCT) design. The data was collected by using electronic databases such as Google Scholar, Science Direct, Pubmed, Scopus, Web of Science, SpringerLink and EBSCOhost in last 10 years, or in 2013-2023. The keywords used curcumin, turmeric, curcuma longa, dysmenorrhea, menstrual pain. Results: There were 7 selected articles in this literature study. Curcumin reduced intensity and duration of dysmenorrhea; the increasing of vitamin D; the reducing of serum IgE, serum aspartate transaminase (AST) and direct bilirubin levels among women with dysmenorrhea. Conclusion: Curcumin was affected to reducing the severity and symptoms of dysmenorrhea.

Prediction of prognosis in patients with ischemic stroke combined with type 2 diabetes mellitus based on serum total bilirubin levels.

Serum bilirubin levels may have therapeutic benefits in oxidative stress-related diseases, but their role in stroke remains unclear. This study aimed to investigate the relationship between serum bilirubin levels on admission and clinical outcomes in ischemic stroke patients. We prospectively collected data from consecutive ischemic stroke admissions. Serum total bilirubin (TBIL) and direct bilirubin levels on admission were measured. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale, and functional status at discharge was evaluated using the modified Rankin scale. Among 180 patients, lower TBIL levels were observed in all 3 groups, with the mild group (7.89 ± 2.12 μmol/L) having lower levels than the moderate group (8.01 ± 2.12 μmol/L) and the severe group (9.12 ± 2.12 μmol/L). Although TBIL levels were initially associated with stroke severity, this relationship did not hold after adjusting for confounding factors. Serum bilirubin levels appear to be related to stroke severity but not independently associated with outcomes in ischemic stroke patients. Further research is needed to understand the underlying mechanisms of this relationship. There is a strong correlation between serum bilirubin levels and the severity and prognosis of ischemic stroke in patients with type 2 diabetes. Therefore, early control of serum TBIL and direct bilirubin is crucial for the treatment and prognosis of ischemic stroke in patients with type 2 diabetes.

Chishao (Paeoniae Radix Rubra) alleviates intra-hepatic cholestasis by modulating NTCP in rats.

Background: Cholestasis is a common pathological manifestation dominated by accumulation of potentially toxic biliary compounds. Na+-taurocholate cotransporting polypeptide (NTCP) plays a critical role in protection from cholestasis and can be targeted therapeutically. Chishao (Paeoniae Radix Rubra) is a clinically efficacious agent for treating cholestasis, but the underlying mechanism has not been fully clarified. Objective: To evaluate the effects of Chishao on the expression of NTCP in rats with alpha-naphthylisothiocyanate (ANIT)-induced cholestasis. Methods: Chishao extracts were obtained by water decoction. Cholestasis model induced by ANIT in rats were established. Thirty rats were divided into five groups: control group (C), ANIT model group (M), 10g/kg Chishao group (LD), 20g/kg Chishao group (MD) and 40g/kg Chishao group (HD). The levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB), alkaline phosphatase (ALP) and total bile acid (TBA) were detected. The mRNA and protein expression of NTCP, multidrug resistance associated protein 2 (MRP2) and bile salt export pump (BSEP) were detected by reverse transcription qPCR and Western blotting respectively. To assess the effects of Chishao on NTCP, MRP2 and BSEP localized at the membrane of hepatocytes, an in vitro experiment involving primary hepatocytes was conducted via the utilization of laser scanning confocal microscopy. Results: The extracts of Chishao significantly improved serum ALT, AST, ALP, TB, DB and TBA (p < 0.05), especially ALP in the HD group (p < 0.01). The histological pathological findings were also reversed in LD, MD and HD groups. The mRNA level of MRP2 was significantly downregulated after treatment with ANIT, whereas it was reversed in MD and HD groups (p < 0.05). The mRNA expression of NTCP was significantly downregulated after ANIT treatment, but dramatically upregulated in the HD group. The expressions of BSEP and MRP2 were similar, but that of NTCP decreased after ANIT treatment, which was reversed significantly by Chishao extracts in a dose-dependent manner. The expression of NTCP in hepatocytes from rats increased dose-dependently after Chishao treatment in vitro. Conclusion: Chishao extracts can improve the serum and histological performances of intra-hepatic cholestasis caused by ANIT, probably by working on transport proteins in liver cell membranes.

Causal inference between serum bilirubin levels and juvenile idiopathic arthritis-associated uveitis: A bidirectional Mendelian randomization study.

Several observational studies have suggested an association between low serum bilirubin levels and Behçet's disease uveitis. However, the causal inference between bilirubin level and juvenile idiopathic arthritis-associated uveitis (JIAU) remains ambiguous. We investigated the potential causal relationship between serum bilirubin levels and JIAU using a bidirectional two-sample Mendelian randomization (MR) framework. We systemically integrated summary-level data from published large-scale genome-wide association studies on bilirubin level and JIAU in a Caucasian British population. To determine the causal effect of bilirubin level on JIAU, we constructed strong instrumental variables using 47 and 80 single-nucleotide polymorphisms (SNPs) specific to direct bilirubin and total bilirubin levels, respectively. For reverse causal inference, seven SNPs associated with JIAU were included in our study. Multiple complementary methods were further performed to evaluate the robustness of MR estimates. The inverse-variance weighted estimate did not show any significant causal associations of genetically predicted serum direct or total bilirubin level with the risk of JIAU (odds ratio [OR]: 1.010, 95% confidence interval [CI]: 0.750-1.359, p = 0.947; OR: 0.867, 95% CI: 0.688-1.093; p = 0.227, respectively). MR-Egger and weighted median methods also obtained similar associations. Additionally, the results of reverse MR analyses using JIAU as exposure showed no associations of genetically predicted risk of JIAU with serum bilirubin levels (p > 0.05). In sensitivity analysis, the causal estimate between serum bilirubin levels and JIAU did not differ when SNPs associated with possible confounders were omitted. Genetic evidence from our bidirectional analysis did not support a causal association between serum bilirubin levels and JIAU risk in the Caucasian British population. Future large-scale studies should be conducted to validate these findings and explore any causal effects on the disease process.

Noninvasive Monitoring of Severe Pulmonary Artery Hypertension in Atrial Septal Defect Patients: Role of Serum Bilirubin Combined with Uric Acid.

Atrial septal defect (ASD) patients commonly experience severe pulmonary arterial hypertension (SPAH), which is frequently associated with a poor prognosis. While serum bilirubin levels, indicative of liver function, are known predictors of right heart failure (RHF), their potential to differentiate SPAH in ASD patients is yet to be ascertained. The purpose of this study was to discover the potential correlations between serum bilirubin levels and ASD patients with SPAH. In this cross-sectional study, 102 ASD patients admitted from December 2019 to November 2020 were enrolled and divided into two cohorts: those with SPAH and those without. Blood tests were conducted to measure serum direct bilirubin (DBIL), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA) and N-terminal pro B-type natriuretic peptide (NT-proBNP). Additionally, all participants underwent transthoracic echocardiography, and invasive hemodynamic data were gathered through right heart catheterization. ASD patients with SPAH exhibited significantly elevated serum DBIL (5.2 3.0 vs. 2.4 1.5 µmol/L, p 0.001) and TBIL (24.6 20.7 vs. 10.1 4.8 µmol/L, p 0.001) levels in comparison to those without SPAH. However, ALT and AST levels remained comparable between the cohorts. Additionally, the SPAH cohort displayed higher serum UA (403.5 131.6 vs. 317.8 67.9 µmol/L, p 0.001) and NT-proBNP levels. Serum DBIL levels, when analyzed independently of other variables, correlated with an increased risk of mean pulmonary arterial pressure (mPAP) in ASD patients ( = 1.620, p = 0.010). A DBIL concentration of 2.15 mg/dL effectively differentiated ASD patients with SPAH from those without, with a sensitivity of 92.9% and a specificity of 51.4% (area under the curve [AUC]: 0.794, 95% confidence interval [CI]: 0.701-0.886, p 0.001). Notably, the combination of DBIL and UA had a higher sensitivity of 92.9% and specificity of 71.6% (AUC: 0.874, 95% CI: 0.799-0.949, p 0.001). Elevated serum DBIL and TBIL levels in ASD patients with SPAH were correlated with poor cardiac function and heightened pulmonary artery pressure. The combination of DBIL and UA has emerged as a strong noninvasive predictor for SPAH in ASD patients, presenting a potentially novel therapeutic biomarker.

Serum Direct Bilirubin as a Biomarker for Breast Cancer.

The role of serum total bilirubin (TB) in cancer has been a subject of controversy, as has the role of its subtypes, particularly serum direct bilirubin (DB). The aim of the present study was to investigate the association between serum DB levels and breast cancer, as well as to assess the diagnostic utility of serum DB in breast cancer. A total of 5299 patients diagnosed with breast cancer for the first time at Taizhou Hospital of Zhejiang Province were included in the study, and 10028healthy physical examination subjects were included as healthy controls. Logistics regression was used to investigate the relationship between serum DB and breast cancer, and the value of serum DB in the diagnosis of breast cancer was assessed by means of receiver operator characteristic (ROC) curve analysis. The serum DB concentration in the breast cancer group was significantly higher than the healthy controls (P < 0.001). Multivariate logistic regression results show that serum DB was an independent risk factor for breast cancer (odds ratio [OR]=4.504, 95% confidence interval [CI]: 4.200-4.831). Subjects with a serum DB concentration in the fourth quartile had a higher risk of breast cancer occurrence compared to those in the first quartile after adjusting for age (OR = 7.155, 95%CI: 6.474-7.907). The optimal cut-off value of serum DB for diagnosing breast cancer was determined to be 2.75μmol/L, with an area under the curve (AUC) of 0.712 (95% CI: 0.703-0.722). This value exhibited good specificity (77.0%) and negative predictive value (77.8%). Serum DB was identified as a risk factor for breast cancer, demonstrating good diagnostic potential for the disease. These findings suggest that serum DB could serve as a promising serum molecular marker for breast cancer.

Prevalence and Associated Factors of Vertebral Fractures in Children with Chronic Liver Disease with and without Liver Transplantation.

To evaluate the prevalence of vertebral fracture (VF) in children with chronic liver disease (CLD) with and without liver transplantation (LT) and to determine the associated factors. A cross-sectional study was conducted. Patients aged 3-21 years with CLD both before and after LT were enrolled in the study. Lateral thoracolumbar spine radiographs were obtained and assessed for VF using Mäkitie's method. Clinical and biochemical data were collected. We enrolled 147 patients (80 females; median age 8.8 years [interquartile range 6.0-11.8]; 110 [74.8%] in the LT group and 37 [25.2%] in the non-LT group). VF was identified in 21 patients (14.3%): 17/110 (15.5%) in the LT group and 4/37 (10.8%) in the non-LT group (p=0.54). Back pain was noted in only three patients with VF. In the univariate analysis, a height z-score below -2.0 (p=0.010), pre-LT hepatopulmonary syndrome (p=0.014), elevated serum direct and total bilirubin levels (p=0.037 and p=0.049, respectively), and vitamin D deficiency at 1-year post-LT (p=0.048) were associated with VF in the LT group. In multivariate analysis, height z-score below -2.0 was the only significant associated factor (odds ratio, 5.94; 95% confidence interval, 1.49-23.76; p=0.012) for VF. All VFs in the non-LT group were reported in males. In children with CLD, VF is common before and after LT. Most patients with VF are asymptomatic. Screening for VF should be considered in patients with a height z-score below -2.0 after LT.

The influence of breed's difference on the hemogram and biochemistry profile of goats raised in Libya during winter.

In Libya, goats are considered as one of the most important livestock in which there are many breeds of goats such as Kurdi, Hegazi, Cyprus, Shami, and Mahali. A little hematological and biochemical information is known on these goat breeds raised in Libya. The main purpose was to verify the effect of breed variations on the hematological and biochemical parameters of goat breeds raised in Libya. The blood samples were collected in the winter season from 70 clinically healthy animals of different breeds for hematology and biochemical analysis. Regarding the effect of breeds on blood hematology, significantly higher number (p < 0.01) of Mid cells were found in Hegazi (3.12 ± 1.30 × 103/µl) and Cyprus (2.41 ± 1.69 × 103/µl) when compared to other goat's breeds including Kurdi (2.28 ± 0.95 × 103/µl), Shami (1.90 ± 0.84 × 103/µl), and Mahali (1.37 ± 0.88 × 103/µl). Moreover, the percentage of Mid cells was highest in Hegazi (22.34% ± 9.40%), 11.40% ± 4.34%), followed by Kurdi (17.71% ± 8.16%), Cyprus (15.84% ± 8.33%), Shami (13.38% ± 5.76%), and lowest in Mahali (11.40% ± 4.34%). There are significant differences (p < 0. 01) in hemoglobin (Hb), red blood cells (RBCs), hematocrit (HCT), mean corpuscular hemoglobin (MCH), red cell width distribution-coefficient of variation (RDW-CV, %), and red cell distribution width-standard deviation (RDW-SD, fl) values among all different breeds of Libyan goats. The results of biochemistry displayed significant changes among the studied goats' breeds, where the highest serum alanine aminotransferase (ALT, U/L) activity was observed in Cyprus (17.81 ± 7.95) and Shami (17.27 ± 1.15) compared with Hegazi (15.31 ± 6.13) and Mahali (14.60 ± 0.46), while Kurdi breed (11.68 ± 7.95) showed the lowest ALT activity. Moreover, significant differences (p < 0.01) in serum lactate dehydrogenase (LDH, U/l), total and direct bilirubin, glucose (GLU), creatinine, lipid profile, and electrolyte levels were recorded among different breeds used in this study. On the other hand, non-significant variations (p >0. 05) are reported in aspartate aminotransferase (U/l), alkaline phosphatase (U/l), total protein (g/dl), albumin (g/dl), urea and magnesium (Mg, mg/dl) levels. These results showed a significant difference between some blood parameters of goat breeds raised in Libya. This could aid veterinarians in interpreting laboratory data properly in order to improve the management and conservation of those breeds.

Suboptimal hepatobiliary phase image in gadoxetic acid-enhanced liver MRI for the evaluation of the HCC: Predictive factors.

To determine the relevant laboratory values for hepatobiliary phase (HBP) imaging and predictive factors for suboptimal HBP images on gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) for the evaluation of hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD). This study included 307 patients with CLD who underwent gadoxetic acid-enhanced liver MRI for HCC evaluation. The liver-portal vein contrast ratio and liver-spleen contrast ratio were calculated from the measurements of the HBP images. In this study, a suboptimal HBP image was defined as the presence of a bright portal vein or a liver-spleen contrast ratio of <1.5. Correlation, comparison, and receiver operating characteristic analyses were performed between the measured parameters on the HBP images and hepatic and renal function tests. The estimated glomerular filtration rate did not correlate with any measured or calculated values on the HBP images. On receiver operating characteristic analysis, the optimal cutoff value for the bright portal vein was an albumin level of 4.05 g/dL (area under the curve, 0.971; sensitivity, 65%; specificity, 82%). The optimal cutoff value of the suboptimal HBP image was a serum direct bilirubin level of 0.83 mg/dL (area under the curve, 0.830; sensitivity, 69%; specificity, 84%). On gadoxetic acid-enhanced MRI for the evaluation of HCC in patients with CLD, suboptimal HBP images were most strongly correlated with serum direct bilirubin levels. Renal function was not associated with suboptimal HBP imaging. Although the sensitivity is low, suboptimal HBP images can be predicted before gadoxetic acid-enhanced liver MRI can be performed.

Therapeutics of L. Lanceolata and V. Doniana on Alcohol Induced Hepatic Pathology

Additive and stimulative properties of alcohol encourage large intake. Notwithstanding, chronic alcohol consumption causes severe hepatic damage, that alters normal biological function of the liver. The aim of this research was to assess the effects of Lophira lanceolata and Vitex doniana extracts on alcohol induced hepatotoxicity using rat model by examining liver serum enzymes (AST, ALT, ALP), lipid peroxidation level, antioxidant enzyme activity and haematological parameters. Thirty Wister rats weighing 70 to 120g were placed in six groups of fives per group. The negative control and treatment groups were familiarized with alcohol (42%) in drinking water before oral administration of 42% consumable alcohol (v/v, 1ml/100g body weight) for nine days. Afterward, the treatment groups were administered 600mg/kg body weight extracts of Lophira lanceolata, Vitex doniana and Vitamin C (as standard drug). Body weight and behavioural characters were monitored during the period. It was observed that, rats in the negative and treatment groups showed significant depletion in weight and negative changes in behaviour. Furthermore, biochemical assessment revealed significant elevated levels of liver serum enzymes (ALT, AST, ALP) activity, total and direct bilirubin, MDA, SOD and CAT while GSH and haematological parameters were significantly depleted at p&lt;0.05. However, the treated groups revealed significant reduction in the liver enzymes, MDA, SOD and CAT while GSH activity and haematological parameters were significantly increased. In conclusion, both extracts have ameliorative and antioxidant properties that could mitigates chronic alcohol hepatotoxicity.

Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage-A Case Series.

Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. PTBD is a very successful strategy for bile leak therapy after pLT.

Severe pathological changes in the blood and organs of SD rats stung by honeybees

With the development of beekeeping, the risk of bee stings in humans is increasing. Severe and life-threatening toxic reactions can occur after multiple bee stings, and their pathogenesis has not been elucidated. To understand the effect of multiple bees (Apis mellifera) stings on the organism in a short period, we stung rats once and five times, respectively. Serum and organs were obtained after 3 h for analysis. The results indicated that skin erythema was more pronounced and hemolysis was more severe as the number of puncture wounds increased. After being stung by five bees, rats had dramatically higher serum levels of direct bilirubin, aspartate aminotransferase, creatine kinase and lactate dehydrogenase, producing more differential metabolites that affected mainly four metabolic pathways. In addition, the liver, kidney and heart showed significant congestion and inflammation. This study helps explain the organism's clinical response to bee venom and may be valuable in treating toxic reactions following bee stings.

Treatment of Patent Ductus Arteriosus in Premature Infants: Intravenous Paracetamol or Oral Ibuprofen?

The similarity in the mechanism of action between paracetamol and ibuprofen can cause similar side effects. However, in preterm neonates with feeding intolerance, intravenous (IV) paracetamol has replaced oral ibuprofen. Therefore, a comparison of the effectiveness and side effects is essential. In this retrospective cohort study, the data of 118 preterm infants with a definite diagnosis of patent ductus arteriosus (PDA), including 59 patients who received oral ibuprofen and 59 patients who received IV paracetamol were analyzed. Laboratory evaluations of serum total and direct bilirubin, hemoglobin, and creatinine levels before and seven days after treatment were made. Using analysis of covariance (ANCOVA) and multiple multinomial logistic regression models, the effect of two treatment groups on the post-treatment variables as well as their efficacy comparison were evaluated. In both pre- and post-treatment periods, there was no significant association between echocardiography variables with treatment groups. The results from the ANCOVA model showed that the paracetamol and ibuprofen were followed by a significant decrease in the mean total bilirubin and Hct variables after treatment by 1.38 and 1.65 units, respectively. In addition, results from the Mann-Whitney U test revealed that the median Hb and K differences after and before treatment had a significant difference between the two treatment groups. Furthermore, based on the multiple multinomial logistic model results, the odds of complete arterial duct closure with IV paracetamol was 1.27 times higher than with oral ibuprofen, while in the oral ibuprofen group, the odds of closing was 1.44 times higher than the IV paracetamol group, but there was no statistically significant difference between the two groups. Intravenous paracetamol has equal efficacy compared to oral ibuprofen in the treatment of PDA. Also, it seems to be associated with a lower risk of hyperbilirubinemia following the treatment.

Higher serum bilirubin levels are associated with hemorrhagic transformation after intravenous thrombolysis in acute ischemic Stroke.

Bilirubin has both antioxidative and prooxidative properties. The study aimed to explore the relationship between serum bilirubin and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke. The patients receiving intravenous thrombolysis with alteplase were retrospectively analyzed. HT was defined as new intracerebral hemorrhage in follow-up computed tomography images within 24-36 h after thrombolysis. Symptomatic intracranial hemorrhage (sICH) was defined as HT accompanied by worsening neurological function. Multivariate logistic regression and spline regression models were performed to investigate the relationship between serum bilirubin levels and the risk of HT and sICH. Among 557 included patients, 71 (12.7%) were diagnosed with HT and 28 (5.0%) developed sICH. Patients with HT had significant higher baseline serum total bilirubin, direct bilirubin, and indirect bilirubin levels than those without HT. Multivariable logistic regression analysis indicated that patients with higher serum bilirubin levels, including total bilirubin (OR 1.05, 95% CI 1.01-1.08, p = 0.006), direct bilirubin (OR 1.18, 95% CI 1.05-1.31, p = 0.004), and indirect bilirubin (OR 1.06, 95% CI 1.02-1.10, p = 0.005) had increased risk of HT. Furthermore, multiple-adjusted spline regression models excluded nonlinear association between serum bilirubin levels and HT (p > 0.05 for nonlinearity). Similar results were present between serum bilirubin and sICH. The data showed the positively linearly relationship between serum bilirubin levels and the risk of HT and sICH in patients with acute ischemic stroke undergoing intravenous thrombolysis.

WITHDRAWN: Construction and evaluation of risk prediction model for kidney injury in patients treated with PD-1 inhibitors

Construction of a nomogram model for predicting the risk of kidney injury associated with programmed cell death protein-1 (PD-1) inhibitors. Patients using PD-1 inhibitors from January 2018 to January 2021 in our center were retrospectively analyzed and followed up until January 2022. Kidney injury was defined as acute kidney disease and disorders (AKD). Univariate and multivariate logistic regression models were used to identify independent risk factors for PD-1 inhibitor associated kidney injury, and nomogram prediction models were further established. A total of 447 patients were included, of whom 71 patients developed AKD. Multivariate logistic regression analysis identified comorbid extrarenal immune related adverse events (irAEs), lower baseline hemoglobin (Hb) level, higher baseline serum creatinine (SCr) and direct bilirubin (DBIL) level as independent risk factors for the development of PD-1 inhibitor associated kidney injury (P < 0.05). A nomogram prediction model was established based on the above independent risk factors. The area under the receiver operating characteristic (ROC) curve (AUC) of the training set and validation set of the model was 0.703 (95% CI 0.628~0.777), 0.791 (95% CI 0.671~0.911), respectively, which suggested that the predictive ability of the model was acceptable. The calibration curves for both the training and validation sets hovered around the ideal line of 45 degrees, suggesting good calibration of the model. Clinical decision curve analysis (DCA) showed that the constructed nomogram curve was far from the two polar end lines, suggesting better clinical benefit of the model. There are many independent risk factors of PD-1 inhibitor related kidney injury. The predictive ability and calibration of the nomogram model established in this study were acceptable and had clinical utility.

Serum Bilirubin Levels and Disease Severity in Patients with Pneumoconiosis.

To investigate the association between serum bilirubin and disease severity in patients with pneumoconiosis. The study comprised 45 patients with pneumoconiosis retrospectively; all pneumoconiosis patients were classified into I, II, and III stage according to the radiological severity. Serum direct bilirubin levels were significantly lower in III stage pneumoconiosis patients than those in I/II stage (p = 0.012) but not serum indirect bilirubin. Serum direct bilirubin was negatively correlated with radiological severity in patients with pneumoconiosis (r = -0.320; p = 0.032); by multiple linear-regression analysis, we observed that serum direct bilirubin levels had independent association with radiological severity in patients with pneumoconiosis (beta = -0.459; p = 0.005). Serum direct bilirubin levels are negatively associated with disease severity in patients with pneumoconiosis.

Serum bilirubin levels are negatively associated with atherogenic lipids in Saudi subjects with type 2 diabetes: A pilot study

&lt;b&gt;Background: &lt;/b&gt;Recent research has demonstrated the possible relevance of bilirubin in metabolic and cardiovascular disorders. Lipid abnormalities are a major problem that is related with an increased risk of cardiovascular disease in diabetics. This study examined the relationship between serum bilirubin and direct bilirubin concentrations and atherogenic lipids in patients with type 2 diabetes (T2DM).&lt;br /&gt; &lt;b&gt;Methods&lt;/b&gt;: This cross-sectional included 67 patients with type 2 diabetes and 39 matched healthy control. The lipid profile, including total cholesterol, HDL-C, and TG levels, fasting blood glucose, total bilirubin, direct bilirubin, ALT, AST, and ALP were measured using a dimension EXL clinical chemistry analyzer (Siemens Healthcare Diagnostics). Cholesterol in VLDL, LDL, and sdLDL were calculated from standard lipid assay results by the equations of Sampson et al.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: Serum bilirubin was lower in non T2DM subjects nearly significant (p=0.0.51) whereas direct bilirubin concentrations were lower in T2DM (p=0.008). ALT, AST, and ALP levels were higher in T2DM groups. The mean values of LDL-C, sdLDL-C, non HDL-C and VLDL-C were significantly increased in T2DM group and lower HDL-C. An inverse relationship could be observed with increase in serum total bilirubin and serum levels of LDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.139, p&amp;lt;0.005), sdLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.137, p&amp;lt;0.005), VLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.074, p&amp;lt;0.044), and non HDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.166, p&amp;lt;0.002) in T2DM group. The same inverse relationship was observed with serum direct bilirubin and serum levels of LDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.133, p&amp;lt;0.006), sdLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.172, p&amp;lt;0.001), VLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.118, p&amp;lt;0.01), and non HDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.182, p&amp;lt;0.001) in T2DM group.&lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;: A significant negative association was found between serum bilirubin levels and direct serum bilirubin with atherogenic lipids, suggesting that serum bilirubin may protect T2DM patients from development of cardiovascular disease. These findings indicate the need for additional research in a large cohort.

Association between bilirubin levels with incidence and prognosis of stroke: A meta-analysis.

Bilirubin has anti-inflammatory, antioxidant, and neuroprotective properties, but the association between bilirubin and stroke remains contentious. A meta-analysis of extensive observational studies on the relationship was conducted. Studies published before August 2022 were searched in PubMed, EMBASE, and Cochrane Library. Cohort, cross-sectional and case-control studies that examined the association between circulating bilirubin and stroke were included. The primary outcome included the incidence of stroke and bilirubin quantitative expression level between stroke and control, and the secondary outcome was stroke severity. All pooled outcome measures were determined using random-effects models. The meta-analysis, subgroup analysis, and sensitivity analysis were performed using Stata 17. A total of 17 studies were included. Patients with stroke had a lower total bilirubin level (mean difference = -1.33 μmol/L, 95% CI: -2.12 to -0.53, P < 0.001). Compared with the lowest bilirubin level, total odds ratio (OR) of the highest bilirubin for the occurrence of stroke was 0.71 (95% CI: 0.61-0.82) and ischemic stroke was 0.72 (95% CI: 0.57-0.91), especially in cohort studies with accepted heterogeneity (I 2 = 0). Serum total and direct bilirubin levels were significantly and positively associated with stroke severity. A stratified analysis based on gender showed that the total bilirubin level in males correlated with ischemic stroke or stroke, which was not noted in females. While our findings suggest associations between bilirubin levels and stroke risk, existing evidence is insufficient to establish a definitive association. Better-designed prospective cohort studies should further clarify pertinent questions (PROSPERO registration number: CRD42022374893).

Changes of biochemical profile of tribal pediatric patients with acute viral hepatitis A at the time of admission - a cross-sectional study

Background: Hepatitis A is a self-limited liver disease which can produce a significant cause of morbidity in parts of the world in pediatric population with low socioeconomic background. Hepatitis A can cause significant changes in liver functions changing its parameters. Aims and Objectives: The aim and objective of the study are to determine the biochemical changes in viral hepatitis A in tribal pediatric patients at the time of admission. Materials and Methods: This cross-sectional observational study was conducted in Deben Mahata Government Medical College and Hospital, Purulia, on confirmed newly diagnosed 100 hepatitis A tribal patients over a period of 12 months. Serum total and direct bilirubin, ALT, AST, alkaline phosphatase, total protein, and albumin were measured and data obtained were analyzed using appropriate statistical method. Results: Data collected from total hepatitis A patients were analyzed. Overall, 53% were male. 71% patients out of 100 presented with serum direct bilirubin level between 0.5 and 2.0 mg/dL and only 4 had more than 4.0 mg/dL. More than 5-fold rise in ALT and AST were seen in 75% and 82% cases, respectively. More than 1000U/L of ALT and AST were seen in 3 cases (3%) and 2 cases (2%), respectively. Among study population, alkaline phosphatase was elevated in 24% cases and 14% cases had hypoproteinemia. Nine cases admitted with raised blood urea level and one case with raised creatinine level. Conclusion: Hepatitis A produces alteration of the parameters of liver function.