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

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yun Cui ◽  
Yijun Shan ◽  
Rongxin Chen ◽  
Chunxia Wang ◽  
Yucai Zhang
Keyword(s):  
Liver Injury ◽  
Pediatric Patients ◽  
Total Bilirubin ◽  
Elevated Serum ◽  
Total Bilirubin Level ◽  
Pediatric Intensive Care ◽  
Serum Levels ◽  
Serum Total Bilirubin ◽  
Kaplan Meier ◽  
Poor Outcomes

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

scholarly journals Risk Factors for Prognosis after the Maze IV Procedure in Patients with Atrial Fibrillation Undergoing Valve Surgery

2021 ◽  
Author(s):  
Shenghua Zhou
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Bilirubin Level ◽  
Right Atrium ◽  
Total Bilirubin ◽  
Elevated Serum ◽  
Total Bilirubin Level ◽  
Valve Surgery ◽  
Serum Total Bilirubin

The present study evaluated risk factors related to persistent atrial fibrillation (AF) at discharge (AF-d) and recurrentatrial fibrillation (rAF) and all-cause death after the maze IV procedure. Two hundred nineteen patients (63 female,aged 52.5 ± 8.8 years) with valve disease and persistent AF undergoing valve surgery and the maze IV procedure in our center between 2015 and 2016 were included. Baseline demographic and clinical data were obtained by review of medical records. The median follow-up period was 27 months (interquartile range 21–34 months) in our patient cohort.The primary end point was all-cause death. The secondary end point was AF-d or rAF. rAF is defined as AF recurrenceat 3 months or later after the procedure. Twenty-eight patients (12.8%) died during follow-up. Multiple logistic regression analysis showed that thrombocytopenia, elevated serum total bilirubin level, a larger right atrium, AF-d, and rAF were independent determinants for all-cause death after the maze IV procedure after adjustment for age, sex, and clinical covariates, including New York Heart Association class III/IV disease, hypertension, and aortic regurgitation, while valvular disease duration and left atrial diameter greater than 80.5 mm were independent determinants for AF-d, and thrombocytopenia, elevated serum total bilirubin level, higher mean pulmonary artery pressure, and AF-d were independent predictors for rAF. In conclusion, thrombocytopenia, elevated serum total bilirubin level, an enlarged right atrium, AF-d, and rAF are independent predictors of all-cause death in patients undergoing the maze IV procedure.

scholarly journals Elevated Serum Free Carnitine Levels in Children with Kawasaki Disease and Their Relation to Unresponsiveness to Intravenous Immunoglobulin: retprospective study

2020 ◽  
Author(s):  
Taichiro Muto ◽  
Nami Nakamura ◽  
Yu Masuda ◽  
Shingo Numoto ◽  
Shunsuke Kodama ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Pediatric Patients ◽  
Total Bilirubin ◽  
Elevated Serum ◽  
Serum Levels ◽  
Free Carnitine ◽  
P Value ◽  
Long Chain Fatty Acids ◽  
Serum Free

Abstract Background Carnitine plays an essential role in transfer of long-chain fatty acids to mitochondria for subsequent β-oxidation. No studies to date have characterized carnitine in children with KD. The objective of this study is to investigate the characteristics of serum free carnitine (FC) in hospitalized pediatric patients with Kawasaki disease (KD). Methods In total, 45 patients with KD measured the levels of serum FC from October 2018 to December 2019 were analyzed retrospectively. We analyzed the clinical and laboratory parameters just before the Intravenous immunoglobulin (IVIG) including serum levels of serum FC with respect to the IVIG response. Results The median age was 33 months. IVIG was effective in 33 children (responders) and was ineffective in 12 (non-responders). The serum FC levels were higher in non-responders than in responders [(35.3 µmol/L (range, 26.8-118.4 µmol/L) vs. 31.4 µmol/L (range, 20.9–81.2 µmol/L), p value = 0.0496]. The FC levels before intravenous immunoglobulin (IVIG) in four-fifths of responders were below the normal range.The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and FC were higher in non-responders than in responders. There was a correlation between FC and AST (R2 = 0.364, P = 0.0015) and between FC and ALT (R2 = 0.423, P < 0.001) levels. Conclusion FC levels were upregulated in patients with KD who were refractory to IVIG. Additionally, FC levels in children with KD correlated with AST and ALT levels. The pathogenesis resulting in the elevation of FC levels remains elusive. Further studies are necessary to understand more precisely carnitine properties in patients with KD.

scholarly journals G6PD genetic variations in neonatal Hyperbilirubinemia in Indonesian Deutromalay population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dewi A. Wisnumurti ◽  
Yunia Sribudiani ◽  
Robert M. Porsch ◽  
Ani M. Maskoen ◽  
Sri E. Rahayuningsih ◽  
...  
Keyword(s):  
G6pd Deficiency ◽  
Total Bilirubin ◽  
Total Bilirubin Level ◽  
Genetic Variations ◽  
Neonatal Hyperbilirubinemia ◽  
Common Finding ◽  
Activity Measurement ◽  
Serum Total Bilirubin ◽  
Indonesian Population ◽  
And Control

Abstract Background Neonatal jaundice is a common finding in newborns in Asia, including Indonesia. In some cases, the serum total bilirubin levels exceeds the 95th percentile for hours of life (neonatal hyperbilirubinemia). Severe neonatal hyperbilirubinemia (NH) could lead to kernicterus and neonatal death. Glucose-6-Phosphage Dehydrogenase (G6PD) genetic variations and deficiency have been reported in several studies to be associated with NH. This study aimed to analyze the G6PD genetic variations and its activity in neonates with and without hyperbilirubinemia in the Deutromalay Indonesian population. Methods Deoxyribose Nucleic Acid (DNA) was isolated from peripheral blood of 116 and 115 healthy term neonates with and without hyperbilirubinemia. All infants underwent the following laboratory examinations: routine hematologic evaluation, Coombs test, G6PD activity measurement using the Randox kit method, and serum total bilirubin level. All exons of the G6PD gene were targeted for deep sequencing using MiSeq (Illumina). An association study of G6PD polymorphisms with NH was performed using PLINK. Results The prevalence of G6PD deficiency in neonates with and without hyperbilirubinemia in Indonesian Deutromalay population were 1.72% (95% Confidence Interval (CI): 0.6–4.1%) and 1.74% (95% CI: 0.7–4.1%), respectively. The most common G6PD polymorphisms, i.e. rs1050757/c.* + 357A > G, rs2230037/c.1311C > T, and rs2071429/c.1365-13 T/IVS11, were identified. However, none of those polymorphisms and their haplotype were associated with NH (p > 0.05, Odds Ratio (OR) ~1.00). The prevalence of G6PD mutations in neonates with and without hyperbilirubinemia were 6.8% (95% CI: 2.3–11.5%) and 6.9% (95% CI: 2.3–11.6%), respectively. The most frequently identified G6PD mutation was the Viangchan variant (p.V291 M), which was followed by the Canton (p.R459L) and Vanua Lava (p.L128P) variants. Two novel mutations were identified both in case (p.V369A, p.I167F) and control (p.L474=, p.I36T) groups. Conclusion The prevalence of G6PD deficiency is low in neonates with or without hyperbilirubinemia in Deutromalay Indonesian population. The majority of G6PD mutations identified among Indonesian Deutromalay population in this study are Viangchan, Canton and Vanua Lava variants.

scholarly journals A High Urinary Urobilinogen / Serum Total Bilirubin Ratio Reported in Abdominal Pain Patients Can Indicate Acute Hepatic Porphyria

2021 ◽  
Author(s):  
Chengyuan Song ◽  
Shaowei Sang ◽  
Yuan Liu
Keyword(s):  
Abdominal Pain ◽  
Roc Curve ◽  
Total Bilirubin ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Total Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Control Groups ◽  
Diagnostic Dilemma ◽  
Laboratory Test Results

Abstract Background: Due to its variable symptoms and nonspecific laboratory test results during routine examinations, acute hepatic porphyria (AHP) has always been a diagnostic dilemma for physicians. Correct diagnosis mainly depends on the elevated urinary porphobilinogen (PBG) level, which is not a routine test performed in the emergency department. Therefore, identifying a more convenient indicator during routine examinations is important to improve the diagnosis of AHP.Methods: In this retrospective study, we enrolled 12 AHP patients and 100 patients with abdominal pain of other causes as the control groups in Qilu hospital of Shandong University between 2015 and 2021. The clinical manifestations and laboratory result data including urinary urobilinogen/serum total bilirubin ratio were compared between these two groups. The diagnostic performance of urinary urobilinogen/serum total bilirubin ratio was measured as sensitivity, specificity, and accuracy. The cut-off for optimal clinical performance was determined by the receiver operator characteristic (ROC) curve. Results were considered significant at a P < 0.05.Results: Compared with the control groups, AHP patients showed a significantly higher urinary urobilinogen level (P < 0.05). However, we showed that the higher urobilinogen level was caused by a false-positive result due to elevated urine PBG. Hence, we used serum total bilirubin, an upstream substance of urinary urobilinogen synthesis, for calibration. A remarkable increase in the urinary urobilinogen/serum total bilirubin ratio was observed in AHP patients. The area under the ROC curve of this ratio for AHP was 1.000 (95% confidence interval, 1.000–1.000, P < 0.01). A cutoff value of 3.22 for the urinary urobilinogen/serum total bilirubin ratio yielded a sensitivity of 100% and a specificity of 100% to distinguish AHP patients from the controls.Conclusion: A reported high urinary urobilinogen level that was adjusted by the serum total bilirubin level (urinary urobilinogen/serum total bilirubin ratio) could be used as a sensitive and specific indicator for AHP in patients with abdominal pain.

Total Bilirubin is a Useful Predictor of Persisting Common Bile Duct Stone in Gallstone Pancreatitis

2008 ◽  
Vol 74 (10) ◽  
pp. 977-980 ◽  
Author(s):  
Tony Chan ◽  
Arezou Yaghoubian ◽  
David Rosing ◽  
Edward Lee ◽  
Roger J. Lewis ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Total Bilirubin ◽  
Bile Duct Stone ◽  
Total Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Gallstone Pancreatitis ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Unnecessary Procedures

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through 2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7 mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones (P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.

scholarly journals Role of serum bilirubin as a marker of acute gangrenous appendicitis

2012 ◽  
Vol 1 (2) ◽  
pp. 89-92 ◽  
Author(s):  
P Ghimire ◽  
P Thapa ◽  
N Yogi ◽  
P Ghimire
Keyword(s):  
Logistic Regression ◽  
Leucocyte Count ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Total Serum ◽  
Total Leucocyte Count ◽  
Serum Total Bilirubin ◽  
Gangrenous Appendicitis ◽  
Significant Difference

Background: This study has compared the difference in serum bilirubin between patients with gangrenous and non-gangrenous appendicitis. Methods: A prospective analytical study of, 141 patients who underwent appendectomy, from March 2010 to March 2011 in Manipal Teaching Hospital, Pokhara, Nepal was carried out. Clinico-demographic data, Alvarado’s score, total serum bilirubin, total leucocyte count and histopathological report of all the cases were collected in a prestructured proforma. Comparison between gangrenous and non-gangrenous appendicitis groups was carried out using independent sample t test, Chisquare test, and direct logistic regression. The data was analyzed using SPSS 11.6 software. Result: Around 43% (61 out of 141) patients had gangrenous appendicitis and statistically significant difference was found between the two groups in total Alvarado’s score, total count and total bilirubin level. The effect size as indicated by eta square statistics was large for total bilirubin (eta squared=0.39) as compared to total Alvarado’s score (0.09) and total leucocyte count (0.05). Direct logistic regression model showed serum total bilirubin as the only independent variable to make a unique statistically significant contribution in predicting gangrenous appendicitis. Conclusion: Pre-operative assessment of serum total bilirubin can serve as an important maker of acute gangrenous appendicitis. DOI: http://dx.doi.org/10.3126/njms.v1i2.6606 Nepal Journal of Medical Sciences. 2012;1(2): 89-92

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