Serum Total Bilirubin Concentration Research Articles

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

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

Anti-diabetic effect of <i>Eucalyptus camaldulensis</i> (Red gum) leaf-supplemented diet in streptozotocin-induced diabetic rats

Purpose: To investigate the potential anti-diabetic effect of supplementing a diet with Eucalyptus camaldulensis leaves in streptozotocin (STZ) induced Wistar rats. 
 Methods: Methanolic extract of E. camaldulensis was screened using gas chromatography-mass spectrometric analysis. After that, eighteen animals were separated into three groups: Group A served as control group. Group B, the diabetic control group, was induced with STZ, and Group C was induced with STZ and fed a 10 % E. camaldulensis leaf-supplemented diet for 14 days. Thereafter, rats were sacrificed, and fasting blood was collected for serum glucose, enzyme and protein activity tests. Organs were excised for biochemical and histological analysis. 
 Results: The GC-MS fingerprint identified 17 constituents, with 2-hydroxy carbazole being the most abundant. Rats on the E. camaldulensis leaf-based diet for 14 days exhibited a significant decrease (p < 0.05) in serum glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, albumin, total bilirubin, urea, and creatinine concentrations compared to diabetic controls. Insulin levels significantly increased (p < 0.05). Additionally, the E. camaldulensis diet led to a significant decrease in serum lipid profile levels but increased high-density lipoprotein cholesterol (HDL-C). Superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities increased significantly, while malondialdehyde levels decreased significantly (p < 0.05). Histopathology revealed positive effects on hepatocytes, acini, pancreatic duodenal lymphoid activation, islets of Langerhans resurgence, and normal kidneys. 
 Conclusion: Eucalyptus camaldulensis leaf-supplemented diet demonstrates anti-diabetic, hypolipidemic and antioxidant enzyme activities. Carbazole identified by GC-MS may be the potential anti-diabetic and hypolipidemic agent in E. camaldulensis leaf-based diet.

Clinical and genetic risk factors associated with neonatal severe hyperbilirubinemia: a case-control study based on the China Neonatal Genomes Project.

Objective: We aimed to investigate the clinical and genetic risk factors associated with neonatal severe unconjugated hyperbilirubinemia. Methods: This was a retrospective, 1:1 matched, case-control study. We included 614 neonates diagnosed with severe unconjugated hyperbilirubinemia (serum total bilirubin level ≥425μmol/L or serum total bilirubin concentration that met exchange transfusion criteria) from the China Neonatal Genomes Project in Children's Hospital of Fudan University. Clinical exome sequencing data were analyzed using a data analysis pipeline of Children's Hospital of Fudan University. The factors associated with severe unconjugated hyperbilirubinemia were assessed using univariable and multivariable logistic regression analyses. Interaction analyses were examined between clinical and genetic risk factors. Results: ABO/Rh incompatibility hemolysis (odds ratio [OR] 3.36, 95% confidence interval [CI] 2.32-4.86), extravascular hemorrhage (OR 2.95, 95% CI 2.24-3.89), weight loss (OR 5.46, 95% CI 2.88-10.36), exclusive breastmilk feeding (OR 3.56, 95% CI 2.71-4.68), and the homozygous mutant of UGT1A1 211G>A (OR 2.35, 95% CI 1.54-3.59) were all identified as factors significantly associated with severe unconjugated hyperbilirubinemia. The presence of UGT1A1 211G>A mildly increased the risk of severe unconjugated hyperbilirubinemia caused by ABO/Rh incompatibility hemolysis (OR 3.98, 95% CI 2.19-7.23), although the effect is not statistically significant. Conclusion: ABO/Rh incompatibility hemolysis, extravascular hemorrhage, weight loss, exclusive breastmilk feeding, and the homozygous mutant of UGT1A1 211G>A were found to be risk factors for severe unconjugated hyperbilirubinemia. Clinical factors remain the most crucial and preventable determinants in managing severe unconjugated hyperbilirubinemia, with a minimal genetic contribution. The establishment of preconception care practices and the reinforcement of screening for the aforementioned risk factors are essential steps for preventing severe unconjugated hyperbilirubinemia.

The Association between Serum Total Bilirubin and Severe Headaches or Migraine in American Adults

Background: Studies about the association between bilirubin and migraine were few. Therefore, the purpose of this study was to investigate the association between serum total bilirubin and the prevalence of severe headaches or migraine. Methods: A multivariable logistic regression was used to assess the association between serum total bilirubin concentration and severe headaches or migraine. We also performed stratified analyses, interaction analyses and multiple interpolations in the sensitivity analysis. Results: This cross-sectional study included 12,552 adults from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. The overall incidence of migraine was 19.99% (2,509/12,552). With every 1 mg/dl increase in bilirubin, the prevalence of migraine decreased by 23% (95% CI: 0.64, 0.93) after adjustment of all related covariates. Similarly, the risk of migraine was reduced by 17% (95% CI: 0.72, 0.97) in the Q4 group (the fourth quartile, highest serum total bilirubin level) compared with the Q1 group (the lowest level). Furthermore, interaction effects by age groups were significant in this relationship (P for interaction = 0.0004). In the Q4 group compared with Q1, inverse associations were observed in those aged ≥40 years (OR: 0.71,95% CI: 0.59, 0.85) in the stratified analysis. Conclusion: These findings support an association between serum total bilirubin and severe headaches or migraine, revealing an inverse association between serum total bilirubin quartiles and severe headaches or migraine in American adults. Age could play an important role in this association.

Noninvasive transcutaneous bilirubin measurement in adults using skin diffuse reflectance.

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

#4074 FRACTIONATED PLASMA SEPARATION AND ADSORPTION INTEGRATED WITH CONTINUOUS VENO-VENOUS HEMOFILTRATION IN PATIENTS WITH ACUTE LIVER FAILURE

Abstract Background and Aims To observe the clinical efficacy and safety of fractionated plasma separation and adsorption integrated with continuous veno-venous hemofiltration (FPSA-CVVH) treatment in patients with acute liver failure (ALF). Method In this retrospective study, we enrolled patients with ALF (serum total bilirubin>10mg/dl or Model for End-Stage Liver Disease (MELD) Score>18) hospitalized from 2017 to 2022.All patients received the treatment of FPSA-CVVH.The primary measure of treatment efficacy was the reduction ratios (RRs) of bilirubin after each session of FPSA-CVVH. Results 8 patients (68 males and 10 females) with ALF were enrolled. 66 patients (84.6%) exhibited acute kidney injury and required renal replacement therapy (RRT). The score of MELD at baseline was 22.9±7.5. The concentration of serum total bilirubin was 22.05±5.94mg/dL, direct bilirubin was 16.33±4.60mg/dL and indirect bilirubin was 3.43±1.60mg/dL.187 sessions of FPSA-CVVH treatment with 8 hours each were performed. After a single session, serum total bilirubin, direct bilirubin and indirect bilirubin were significantly decreased. RRs was 52.0±7.6% for total bilirubin, 59.4±13.0% for direct bilirubin and 36.9±15.4% for indirect bilirubin. 2 patients changed the filters due to blood coagulation. And other 2 patients exhibited bleeding, including gastrointestinal bleeding and Oozing bleeding. 29 patients (37.2%) survived in discharging from hospital, 12 patients recovered with their liver function, and the remaining 17 patients still needed intermittent artificial liver support therapy. Conclusion FPSA-CVVH therapy was a novol and effective artificial liver support therapy in patients with ALF. It may be considered as a “bridge technique” to the recovery of liver function in critical ill patients with ALF.

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common & in most1cases, benign problem in1first month of1life which is often1physiologic & intervention is not1usually1necessary. In the first week of life, about 60.0% of term & 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct & indirect1bilirubin concentrations were determined. Serum total,1direct& indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age > 9 days (p=0.00). Advanced maternal age (>30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common & in most1cases, benign problem in1first month of1life which is often1physiologic & intervention is not1usually1necessary. In the first week of life, about 60.0% of term & 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct & indirect1bilirubin concentrations were determined. Serum total,1direct& indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age > 9 days (p=0.00). Advanced maternal age (>30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Habitual fish consumption and healthy lifestyle behaviours may be associated with higher total serum bilirubin level and anti-inflammatory activity: a cross-sectional study.

Habitual fish consumption and a healthy lifestyle are associated with lower atherosclerotic CVD (ASCVD) risk. Mildly elevated bilirubin, an end product of Hb metabolism, may be associated with anti-inflammatory effects, suppressing ASCVD risk. No data exist on the relationship between fish consumption, total serum bilirubin (TSB) and inflammation in clinical settings. We conducted a cross-sectional study between April 2019 and March 2020 in a cohort of 8292 participants (average age, 46·7 (sd 12·9) years and 58·9 % men) with no history of ASCVD and TSB concentrations < 2·0 mg/dl. Multiple stepwise regression analysis showed Hb concentrations were a solid positive determinant of TSB concentrations (β = 0·302, P< 0·0001). Fish consumption (β = 0·025, P= 0·019) and aerobic exercise (β = 0·021, P= 0·043) were statistically weak but significantly positive determinants of TSB concentrations. Cigarette smoking negatively affected TSB concentrations (β = −0·104, P< 0·0001). Moreover, with increasing fish consumption, the proportion of participants with a habit of cigarette smoking decreased, and that of participants who engaged in aerobic exercises increased (P< 0·0001 for both). Furthermore, as TSB concentrations increased, the leukocyte counts and C-reactive protein concentrations decreased (P< 0·0001 for both). In conclusion, despite the lesser relevance given to TSB concentrations than Hb concentrations, higher fish consumption and healthier lifestyle behaviours related to fish consumption habits may be additively or synergistically associated with higher TSB concentrations and anti-inflammatory activity, leading to attenuated ASCVD risk. Further investigations are needed to clarify the causal relationships between these factors.

Management of a pregnancy with Crigler-Najjar syndrome type 2: a case report

Objective: To report a case with Crigler-Najjar syndrome type 2 of elevated bilirubin levels who was treated with triple therapy. Case(s): Crigler-Najjar syndrome is a rare congenital disorder that causes non-obstructive non-hemolytic unconjugated jaundice. The syndrome is divided into two groups according to the severity and the clinical presentation of the disease. In these cases, there is an elevated risk of antenatal death or permanent neurological impairment of the fetus due to fetal kernicterus caused by excessively increased unconjugated bilirubin levels. Phototherapy, phenobarbital and plasmapheresis can be useful in reducing serum total bilirubin concentrations, thus adverse maternal and neonatal risks. Conclusion: At her 37 weeks of gestation, the patient delivered a healthy girl. No pathological neurological findings were found and the baby had normal growth with intact neurological development.

The Preclinical Benefit of Glutamine in bisphenol A-induced Hepatotoxicity in Wistar Rats

Background: Oxidative stress may be a causative factor for bisphenol A (BPA) -induced hepatotoxicity. Glutamine (GM) is an amino acid with the ability to inhibit oxidative stress. Objective: This study evaluated the ability of GM to prevent BPA-induced hepatotoxicity in rats. Methods: Adult Wistar rats of both sexes (n=30) were used. The rats were randomly grouped into six of five rats each. Groups A (Control), B, and C were treated with normal saline (0.2 mL), GM (80 mg/kg), and BPA (50 mg/kg), respectively for 60 days. Groups D-F were treated with GM (20 mg/kg)+BPA (50 mg/kg), GM (40 mg/kg)+BPA (50 mg/kg), and GM (80 mg/kg)+BPA (50 mg/kg), respectively for 60 days. After treatment, blood and liver samples were obtained for biochemical and histological assessments, respectively. Results: Significantly (P&lt;0.01) decreased body weight and significantly (P&lt;0.01) increased liver weight occurred in the BPA-administered group when compared to the control group. The BPA-administered group showed significantly (P&lt;0.001) elevated serum total bilirubin, lactate dehydrogenase, aminotransferases, conjugated bilirubin, gamma-glutamyl transferase, alkaline phosphatase, and liver malondialdehyde concentrations when compared to the control group. Significantly (P&lt;0.001) decreased liver superoxide dismutase, glutathione peroxidase, catalase, and glutathione levels occurred in the PBA-administered group when compared to the control group. BPA caused hepatocyte necrosis, sinusoids, and central vein congestion. BPA-induced hepatotoxicity was reversed by GM; 20 mg/kg (P&lt;0.05), 40 mg/kg (P&lt;0.01), and 80 mg/kg (P&lt;0.001) in a dose-related fashion when compared to BPA. Conclusion: GM may be effective against BPA-associated hepatotoxicity.

Association of the changes in hepatic enzymes, bilirubin, and plasma proteins with beta-thalassemia in iron over loaded-patients

Changes in liver enzymes and bilirubin in patients with thalassemia depend on genetic changes and the association of other genetic determinants. Iron overload is associated with increased morbidity in both transfusion-dependent and non-transfusion-dependent thalassemia patients. The main objective was to evaluate hepatic enzymes, bilirubin and plasma proteins in βTM patients and also to study the correlations of these parameters with serum hemoglobin and ferritin concentrations in βTM patients. To achieve this goal, the study was directed on two groups, the first is case group includes 39 patients with βTM and the second control group includes 34 subject. Serum ALT, AST, total bilirubin, albumin and total protein concentrations were measured by UV-Vis Spectrophotometer, while the concentration of serum ferritin was measured by ELISA Kit. Our results showed that there are highly significant differences between beta thalassemia major and ferritin at mean (2942.71) , furthermore there are highly significant differences between beta thalassemia major and liver enzymes at (71.98) for AST , (69.42) for ALT, (6.98) for Total protein, (3.92) for Albumin and (2.32) for Total bilirubin. In addition our findings showed there are Correlations between serum ferritin concentrations and liver function testes in βTM patients, where there are highly significant differences between beta thalassemia major and Alanine transaminase at mean (r = 0.44), while the Correlation between serum hemoglobin concentration and liver function testes showed highly significant differences between beta thalassemia major and aspartate aminotransferase at mean (r = 0.52). The study concluded that the increase in serum liver enzymes (ALT, AST) and total bilirubin concentrations in patients with βTM are indicator to liver dysfunction that is correlated to iron overload.

Assessment of serum and drain fluid bilirubin concentrations in liver transplantation patients

Bile leakage is a major complication after liver transplantation and remains as a significant source of morbidity and mortality. In 2011, the International Study Group of Liver Surgery (ISGLS) defined bile leakage as a drain/serum bilirubin ratio ≥3. However, to our knowledge there is no literature assessing serum and drain bilirubin concentrations after liver transplantation. The aim of this study was to describe the natural postoperative changes in serum and drain fluid bilirubin concentrations in patients after liver transplantation. We included 32 patients who underwent liver transplantation at Kobe University Hospital from January 2007 to December 2020. We enrolled 34 living donors who had no complications as the control group. The recipient serum total/direct bilirubin concentration were higher compared with the donors from postoperative day (POD) 1 to 5 with a statistical difference (P < .05). The recipient drain/serum total bilirubin ratio was lower than donors on POD 3 (0.89 ± 0.07 vs 1.53 ± 0.07: P < .0001), which was also confirmed by the recipient drain/serum direct bilirubin ratio (0.64 ± 0.10 vs 1.18 ± 0.09: P < .0001). On POD 3, the drain fluid volume (647.38 ± 89.47 vs 113.43 ± 86.8 mL: P < .001) and serum total bilirubin concentration (6.73 ± 0.61 vs 1.23 ± 0.60 mg/dL: P < .001) was higher in the recipients than in donors. Categorized in 2 groups, the higher drain fluid volume and bilirubin concentration recipients showed lower drain/serum total bilirubin ratio compared with the other group (P=.03) CONCLUSION: The drain/serum bilirubin ratio in the transplanted patients could be calculated lower compared with the hepatectomy patients because of high drain fluid volume and hyperbilirubinemia. Great care should be taken when assessing the bile leakage in liver transplant recipients using the ISGLS definition.

The influence of steroid therapy of complications of infectious mononucleosis on the course of Epstein-Barr virus hepatitis.

The purpose of the study was to characterize the differences in the course of Epstein-Barr virus (EBV) primary infection-induced hepatitis between patients treated with steroids due to complications of infectious mononucleosis (IM) and those not receiving such therapy. We analyzed the changes in the activity of liver enzymes and differences in abdominal ultrasound results. The study was based on reviewing the medical records of children hospitalized for primary EBV infection at the Department of Children's Infectious Diseases, Medical University of Warsaw, Regional Hospital of Infectious Diseases in Warsaw, between August 2017 and March 2023. The study population was divided into two groups: patients treated with steroids (Group 1) and children not receiving steroids (Group 2). Significant differences were obtained for alanine aminotransferase activity only in the first week of IM (205.34 ±115.40 vs. 288.82 ±170.16 IU/l for Group 1 and 2, respectively; p = 0.024), and for aspartate aminotransferase in the first (170.63 ±159.47 vs. 218.85 ±128.22 IU/l for Group 1 and 2, respectively; p = 0.009) and the third week (151.09 ±138.57 vs. 235.50 ±170.27 IU/l for Group 1 and 2, respectively; p = 0.016). The analysis of the results of laboratory tests for the diagnosis of cholestasis (γ-glutamyl transferase and total serum bilirubin concentrations with fractions) did not show significant differences between the groups. Our results indicated that the two cohorts of patients may differ in the course of hepatitis associated with primary EBV infection, especially at the beginning of the disease, when the laboratory features of hepatitis were less pronounced in children treated with steroids.

PS-C17-5: HYPOBILIRUBINEMIA AND HYPERTENSION AS RISK FACTORS FOR DIABETIC RETINOPATHY OF TYPE 1 AND TYPE 2 DIABETES MELLITUS

Objective: Previously, we reported that hypobilirubinemia is an important risk factor for diabetic retinopathy. On the other hand, high systolic blood pressure (SBP) is reported to be a risk factor for this condition. Therefore, we conducted this retrospective study to evaluate a significance of hypobilirubinemia and hypertension as risk factors for diabetic retinopathy of type 1 and type 2 diabetes mellitus (DM). Design and Methods: One hundred and thirty-one patients (59 men) with type 1 and 293 patients (159 men) with type 2 DM were included in this cross-sectional study. We compared serum total bilirubin concentration (TBC) between the patients with and without diabetic retinopathy, and compared it according to the severity of retinopathy. Logistic regression analysis was used to examine the effects of various factors on retinopathy, and the following factors were considered as independent variables: SBP, TBC, gender, age, diabetes duration, HbA1c, eGFR, and BMI. Results: The age, diabetes duration, BMI, HbA1c and TBC of the subjects with type 1 and type 2 DM were 54.9 + 15.0 years, 17.4 + 12.2 years, 21.9 + 3.6 kg/m2, 7.9 + 1.5%, 0.70 + 0.24 mg/dL and 64.1 + 12.8 years, 14.4 + 9.5 years, 25.4 + 5.4 kg/m2, 9.2 + 1.8%, 0.75 + 0.29 mg/dL, respectively. Forty-three (33%) patients with type 1 and 124 (42%) patients with type 2 DM patients were complicated by diabetic retinopathy, respectively. Sixty (46%) patients with type 1 and 211 (72%) patients with type 2 DM were complicate by hypertension. Among type 1 and type 2 DM patients, SBP was higher and TBC was lower significantly in patients with retinopathy than in those without retinopathy. It was shown that serum TBC was negatively associated with increasing severity of retinopathy in patients with both type 1 and type 2 DM. The results of logistic regression analysis showed that TBC was an independent explanatory factor for retinopathy of both type 1 (p = 0.001) and type 2 (p &lt; 0.001) DM. Among type 1 diabetics, systolic blood pressure was an independent risk factor (p = 0.001), but SBP was not (p = 0.067). Conclusions: Low TBC might have pathophysiological significance in the onset of retinopathy for both type 1 and type 2 DM patients. On the other hand, the significance of hypertension might be higher for type 2 than type 1 DM.

Evaluation of a Point-of-Care Test for Bilirubin in Malawi.

BiliSpec is a low-cost spectrophotometric reader and disposable paper-based strip to quantify total serum bilirubin from several blood drops. This study was a prospective evaluation of BiliSpec in 2 neonatal wards in Malawi compared with a reference standard bilirubinometer over a large range of bilirubin and hematocrit levels. The accuracy of BiliSpec and a transcutaneous bilirubinometer were compared with the reference standard of spectrophotometry for 475 blood samples collected from 375 subjects across a range of total serum bilirubin concentrations from 0.0 to 33.7 mg/dL. The development of error grids to assess the clinical effects of measurement differences is reported. BiliSpec was found to have a mean bias of -0.48 mg/dL and 95% limits of agreement of -5.09 mg/dL to +4.12 mg/dL. Results show 90.7% of BiliSpec measurements would have resulted in the same clinical decision as the reference standard, whereas 55.0% of transcutaneous bilirubin measurements would have resulted in the same clinical decision as the reference standard. This evaluation supports use of BiliSpec to provide accurate, low-cost, point-of-care bilirubin measurements in low-resource hospitals. Future work is needed to evaluate BiliSpec among a larger number of users.

Effect of Common Chicory Essence and Phototherapy on Serum Bilirubin Levels in Preterm Infants Admitted to Neonatal Intensive Care Unit: An In Vitro Study

: Jaundice is a common neonatal disorder that occurs in most term and preterm infants. Chicory or dandelion flower has long been used in the treatment of jaundice. This study aimed to investigate the effect of common chicory essence and phototherapy on serum bilirubin levels in preterm infants admitted to the neonatal intensive care unit (NICU) of Valiasr Hospital in Birjand, Iran. This in vitro study was conducted on preterm infants with gestational age of less than 37 weeks and weight less than 2500 g. Bilirubin levels in blood samples from 21 infants were measured before and after the addition of chicory essence or distilled water. Then, phototherapy was performed, and bilirubin levels were measured again. Data were analyzed using SPSS (version 21). The mean weight of infants was 1542.8 ± 453.5 g. In the chicory essence group, the mean total serum bilirubin was 5.29 ± 1.55 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P &lt; 0.001). The mean indirect serum bilirubin was 4.96 ± 1.59 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P &lt; 0.001). The mean changes in total bilirubin in the distilled water and chicory groups were 5.15 ± 1.70 and 5.43 ± 1.99 mg/dL, respectively (P = 0.62). The results showed that both distilled water and chicory essence decreased direct and total serum bilirubin concentrations. The indirect bilirubin changes were not significant, and there was no difference in the total bilirubin changes between the two groups. Totally, the chicory essence had no effect on reducing the serum bilirubin level in preterm infants.

Protective Activity of Chloroform Extract of Gomphrena celosioides Leaves (Amaranthaceae) on Some Biochemical Indices in Aspirin-induced Wistar Rats

The protective activities of Gomphrena celosioides on Aspirin-induced alterations in biochemical markers were investigated in the kidney and liver of Wistar rats. Serum creatinine and blood urea nitrogen concentrations were assessed to determine biochemical alteration in the kidney, while total bilirubin and direct bilirubin concentrations were assessed to determine biochemical alteration in the liver. Four groups of rats were used. In group 1, the control rats were treated with 1% Gum Acacia solution. Group 2 was treated with Aspirin at 200 mg/kg b.w alone. Group 3 was treated with Aspirin at 200 mg/kg b.w and G. celosioides at 500 mg/kg b.w while Group 4 received G. celosioides at 500 mg/kg b.w. All the administration and treatment lasted for 7 days. A significant increase (P &lt; 0.05) in the concentrations of serum creatinine (69.60 ± 4.16 mg/dl), total bilirubin (38.36 ± 5.33 mg/dl), direct bilirubin (15.17 ± 2.22 mg/dl) and blood urea nitrogen (27.05 ± 4.85 mg/dl) was observed in the rats treated with 200 mg/kg b.w aspirin. There was significant decrease (P &lt; 0.05) in the concentrations of creatinine, total bilirubin, direct bilirubin, and blood urea nitrogen in the rats in group 3 (59.58 ± 2.972 mg/dl, 31.41 ± 6.22 mg/dl, 11.09 ± 1.40 mg/dl, 13.12 ± 0.67 mg/dl) and in rats in group 4 (53.2 ± 1.16 mg/dl, 32.19 ± 3.36 mg/dl, 13.49 ± 4.06 mg/dl, 10.63 ± 3.16 mg/dl) when compared with rats in group 2. While there was no significant (P &lt; 0.05) difference when compared with group 1 (control) (52.20 ± 3.25 mg/dl, 30.75 ± 1.23 mg/dl, 12.46 ± 1.12 mg/dl, 7.29 ± 2.07 mg/dl). The results reveal that G. celosioides can provide significant protection against biochemical alterations in aspirin-treated rats.

Study on the application value of red blood cell distribution width and platelet distribution width in neonatal exchange transfusion with hyperbilirubinemia

Purpose The study aimed to evaluate the application of Red Blood Cell Distribution Width (RDW) and Platelet Distribution Width (PDW) in the treatment of neonatal exchange transfusion (ET) with hyperbilirubinemia as well as to provide relevant reference materials for clinical diagnosis and treatment. Patients and methods This was a retrospective study in a single center. Between January 2011 and December 2020, a total of 198 neonates, who were admitted to Fujian Maternity and Child Health Hospital for hyperbilirubinemia and treated with ET therapy were selected. They were divided into blood group antibody negative (BGAbN) ET (n = 92) and blood group antibody positive (BGAbP) ET (n = 106) groups. We analyzed changes in serum total bilirubin (STB), serum indirect bilirubin (SIB), and platelet count(PLT) before and after ET; The clinical data of the neonates with hyperbilirubinemia were collected, and RDW and PDW were compared in the two groups before ET.. Results The concentrations of STB, SIB, and platelet count were much higher before ET and decreased significantly after ET; the difference was statistically significant (p<.001); There were significant differences between the two groups in RDW and PDW before ET. Conclusion ET therapy is the most timely and effective treatment method for severe hyperbilirubinemia in neonates clinically; RDW and PDW can help determine neonatal hemolysis caused by blood group antibodies.

Prediction of outcomes after second-line treatment for acute graft-versus-host disease

AbstractAcute graft-versus-host disease (GVHD) requiring second-line treatment represents a highly morbid complication of allogenic hematopoietic cell transplantation (HCT). Recent studies have defined short-term outcomes after second-line treatment for acute GVHD, but longer-term outcomes have not been well defined. We examined overall survival (OS) and failure-free-survival (FFS) of 216 patient who had HCT who received second-line treatment for acute GVHD. Failure time for FFS was defined as the earliest of death, relapse, or implementation of third-line treatment. Multivariable Cox regression was used to identify risk factors for mortality and failure, and predictive models were derived for 6- and 12-month mortality. Point estimates of OS at 6 and 12 months were 59% (95% confidence interval [CI], 52-65) and 52% (95% CI, 45-68), respectively. Point estimates of FFS at 6 and 12 months were 42% (95% CI, 35-48) and 37% (95% CI, 31-43), respectively. Predictive models for both end points included serum albumin and total bilirubin concentrations at the onset of second-line treatment, patient age at onset of second-line therapy, and a combination of abdominal pain/stage 4 gut involvement. Optimism-corrected areas under the receiver-operator characteristic curve and Brier scores were 77.4 and 0.169 for 6-month mortality, respectively, and 80.0 and 0.169 for 12-month mortality. We identify risk factors associated with mortality and failure after second-line treatment of acute GVHD, provide historical benchmarks for assessment of FFS and OS in other studies, and propose predictive models for 6- and 12-month mortality that could be used to generate population-specific benchmarks.