scholarly journals Direct Bilirubin in Drainage Fluid 3 days after Hepatectomy Is Useful for Detecting Severe Bile Leakage

2021 ◽  
pp. 1-7
Author(s):  
Norifumi Harimoto ◽  
Kenichiro Araki ◽  
Takahiro Yamanaka ◽  
Kei Hagiwara ◽  
Norihiro Ishii ◽  
...  
Keyword(s):  
Predictive Value ◽  
Total Bilirubin ◽  
Area Under The Curve ◽  
International Study ◽  
Bile Leakage ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Drainage Fluid ◽  
Clinically Significant ◽  
Definition Of

<b><i>Introduction:</i></b> The International Study Group of Liver Surgery (ISGLS) definition of bile leakage is an elevated total bilirubin concentration in the drainage fluid after post-operative day (POD) 3, which has been widely accepted. However, there were no reports about direct bilirubin in drainage fluid to predict bile leakage. <b><i>Methods:</i></b> Data from 257 patients who underwent hepatectomy were retrospectively reviewed. The optimal cut-off value was investigated using receiver-operating characteristic curves. The predictive power of drainage fluid total bilirubin (dTB) and drainage fluid direct bilirubin (dDB) to predict bile leakage, which was defined using ISGLS grade B or grade C, were compared. <b><i>Results:</i></b> ISGLS grade B bile leakage occurred in 16 patients (6.2%). Area under the curve (AUC) of dDB was always higher than that of dTB on each POD. The AUC of dDB was &#x3e;0.75 on PODs 2, 3, and 5, and then it increased with the increasing POD. The dDB on POD 5 showed the highest accuracy (0.91) and positive predictive value (PPV) (0.67), which was followed by dTB/serum total bilirubin (sTB) on POD 3 (accuracy, 0.91; PPV, 0.33). Because the PPV of dDB increased as the POD increased, dDB was better than dTB for predicting clinically significant bile leakage. dDB on POD 3 showed the highest negative predictive value (0.97). The positive likelihood of dDB increased and the negative likelihood of dDB decreased on the basis of the POD. Among patients with dTB/sTB ≤3 on POD 3, 19.1% of these patients had bile leakage when dDB was &#x3e;0.44 on POD 3. <b><i>Conclusions:</i></b> Measurement of both dDB and dTB, which are easy to perform, can be used to effectively predict clinically significant bile leakage.

scholarly journals Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients

2020 ◽  
Vol 9 (12) ◽  
Author(s):  
Jiancheng Wang ◽  
Xianglin Zhang ◽  
Zhuxian Zhang ◽  
Yuanyuan Zhang ◽  
Jingping Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Cox Proportional Hazards ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Inverse Association ◽  
Baseline Serum ◽  
Hypertensive Patients

Background Data on the association between serum bilirubin and the risk of stroke are limited and inconclusive. We aimed to evaluate the association between serum bilirubin and the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. Methods and Results Our study was a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). A total of 19 906 hypertensive patients were included in the final analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for the risk of first stroke associated with serum bilirubin levels. The median follow‐up period was 4.5 years. When serum total bilirubin was assessed as tertiles, the adjusted HR of first ischemic stroke for participants in tertile 3 (12.9–34.1 μmol/L) was 0.75 (95% CI, 0.59–0.96), compared with participants in tertile 1 (<9.3 μmol/L). When direct bilirubin was assessed as tertiles, a significantly lower risk of first ischemic stroke was also found in participants in tertile 3 (2.5–24.8 μmol/L) (adjusted HR, 0.77; 95% CI, 0.60–0.98), compared with those in tertile 1 (<1.6 μmol/L). However, there was no significant association between serum total bilirubin (tertile 3 versus 1: adjusted HR, 1.45; 95% CI, 0.89–2.35) or direct bilirubin (tertile 3 versus 1: adjusted HR, 1.27; 95% CI, 0.76–2.11) and first hemorrhagic stroke. Conclusions In this sample of Chinese hypertensive patients, there was a significant inverse association between serum total bilirubin or direct bilirubin and the risk of first ischemic stroke.

scholarly journals Prediction of Hyperbilirubinemia in Preterm Newborns Admitted in a Tertiary Care Teaching Hospital

2013 ◽  
Vol 37 (2) ◽  
pp. 85-89
Author(s):  
Farhana Rahat ◽  
Mahfuza Shirin ◽  
Md M Monir Hossain
Keyword(s):  
Negative Predictive Value ◽  
Gestational Age ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Tertiary Care ◽  
Serum Total Bilirubin ◽  
Indirect Bilirubin ◽  
Study Population ◽  
Safe Limit ◽  
Preterm Newborns

Introduction: Neonatal hyperbilirubinemia is a cause of major concern for the parents as well as the pediatricians due to chance of neurotoxicity. Early prediction of development of significant hyperbilirubinemia can reduce anxiety and duration of hospital stay. Objective: To find out the risk of development of significant hyperbilirubinemia among preterm newborn within first seven days of life. Methodology: This prospective study was carried out in Dhaka Shishu Hospital during the period of January to June, 2007. One hundred & eleven preterm newborns of 30-37 weeks gestational age were enrolled in first day of their life and their serum total and indirect bilirubin were estimated on the 1st, 2nd, 5th & 7th day. Neonates with evidence of hemolysis, direct hyperbilirubinemia, sepsis & major congenital malformation were excluded. Their 1st and 2nd day serum total bilirubin values were analyzed statistically at different cut off points from which significant hyperbilirubinemia can develop on 5th & 7th day of life. Results: The study included 111 premature neonates of 30-37 weeks gestation who were enrolled on first day of their life. Their mean gestational age was 33.7(±2) weeks and mean birth weight was 1754(±341) gm. Of them, 38 (34%) neonates developed significant hyperbilirubinemia within first seven days of life. Among the study population, 40 (36%) neonates had serum total bilirubin value of <2 mg/dL on first day of life. None of them developed significant hyperbilirubinemia (100% negative predictive value). Again 65 (58.5%) neonates had serum total bilirubin value of <5 mg/dL on second day of life. Among them only 7.6% developed significant hyperbilirubinemia (92.3% negative predictive value). Conclusion: The first and second day serum total bilirubin values can predict subsequent hyperbilirubinemia within seven days of life. First day serum total bilirubin value of 2 mg/dL can be taken as a safe limit from which chance of significant hyperbilirubinemia is less. DOI: http://dx.doi.org/10.3329/bjch.v37i2.17265 BANGLADESH J CHILD HEALTH 2013; VOL 37 (2) : 85-89

Comparing Micro-Ultrasound to mpMRI in Detecting Clinically Significant Prostate Cancer

2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Guan Hee Tan ◽  
Brian Wodlinger ◽  
Christian Pavlovich ◽  
Laurence Klotz
Keyword(s):  
Prostate Cancer ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Grade Group ◽  
Interval Method ◽  
Lower Specificity ◽  
Lesion Analysis ◽  
The Difference ◽  
Clinically Significant ◽  
Jeffreys Interval

Objectives To compare the performance of micro-ultrasound (mUS) with multi-parametric magnetic resonance imaging (mpMRI) in detecting clinically significant prostate cancer. Materials and Methods Retrospective data from consecutive patients with any indication for prostate biopsy in 2 academic institutions were included. The operator, blinded to mpMRI, would first scan the prostate and annotate any mUS lesions. All mUS lesions were biopsied. Any mpMRI lesions that did not correspond to mUS lesion upon unblinding were additionally biopsied. Grade group (GG) ≥ 2 was considered clinically significant cancer. The Jeffreys interval method was used to compare performance of mUS with mpMRI with the non-inferiority limit set at −5%. Results Imaging and biopsy were performed in 82 patients with 153 lesions. mUS had similar sensitivity to mpMRI (per-lesion analysis: 78.4% versus 72.5%), but lower specificity, positive predictive value, negative predictive value, and area under the curve. Micro-ultrasound found GG ≥ 2 in 13% of cases missed by mpMRI, while mpMRI found GG ≥ 2 in 11% of cases missed by mUS. The difference 0.020 (95% CI −0.070 to 0.110) was not statistically significant (P = 0.33). Conclusion The sensitivity of mUS in detecting GG ≥ 2 disease was similar to that of mpMRI, but the specificity was lower. Further evaluation with a larger sample size and experienced operators is warranted.

scholarly journals The Predictivity of Serum Biochemical Markers in Acute Biliary Pancreatitis

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Bülent Güngör ◽  
Kasım Çağlayan ◽  
Cafer Polat ◽  
Deniz Şeren ◽  
Kenan Erzurumlu ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Biochemical Markers ◽  
Total Bilirubin ◽  
Direct Bilirubin ◽  
Gamma Glutamyl Transferase ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Glutamyl Transferase

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis.

scholarly journals CD14/-159 and TNFα/-308 Promoter Polymorphisms are not associated with Development of Idiopathic Neonatal Hepatitis among Filipinos

2017 ◽  
Vol 51 (3) ◽  
Author(s):  
Florence Giannina F. San Juan ◽  
Annavi Marie G. Villanueva ◽  
Germana Emerita V. Gregorio ◽  
Catherine Lynn T. Silao
Keyword(s):  
Alkaline Phosphatase ◽  
Total Bilirubin ◽  
Direct Sequencing ◽  
Direct Bilirubin ◽  
Neonatal Hepatitis ◽  
Serum Total Bilirubin ◽  
Promoter Polymorphisms ◽  
Baseline Serum ◽  
Significant Difference ◽  
Idiopathic Neonatal Hepatitis

Objective. To determine if the CD14/-159 and the TNFα/-308 single nucleotide polymorphisms (SNPs) are associated with the development of Idiopathic Neonatal Hepatitis (INH) in Filipino children. Methods. Genomic DNA from 33 patients diagnosed with INH and 33 age- and sex-matched controls, children without any liver disease, were recruited. Baseline serum total bilirubin (TB), direct bilirubin (DB), and alkaline phosphatase (ALP) of the patients were obtained from their medical records. Genotypes for CD14/159 and TNFα/-308 were determined via PCR and direct sequencing. Results. No significant difference was seen between the frequency of the CD14/-159 T allele (p=0.86) nor the TNFα/-308 A allele (p=0.62) between INH patients and controls. There was also no significant difference between the genotypic distribution of the INH and control populations for both CD14/-159 (p=0.54) and TNFα/-308 (p=0.62). There were also no significant differences noted between the different genotypes of CD14/159 and TNFα/-308 and levels of alkaline phosphatase (p=0.65, p=0.91), total bilirubin (p=0.89, p=0.75), and direct bilirubin (p=0.93, p=0.68). Conclusion. In this preliminary study, CD14/-159 and TNFα/-308 showed no association with the development of INH among Filipinos.

scholarly journals Clinical Significance of Serum Bilirubin in the Diagnosis of Atypical Acute Appendicitis

2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Shunxin Hao ◽  
Lisha Zhao
Keyword(s):  
Liver Function ◽  
Acute Appendicitis ◽  
Clinical Significance ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Serum Bilirubin Level ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin

Objective: To investigate the significance of serum bilirubin in the diagnosis of atypical acute appendicitis. Methods: perform a retrospective analysis of 120 patients with atypical acute appendicitis diagnosed in our hospital from July 2012 to July 2016. All patients underwent routine liver function tests before surgery. Results: 83 patients were confirmed by surgery as acute appendicitis, of which 68 patients had elevated serum total bilirubin and direct bilirubin, and 15 patients were normal; 37 patients were confirmed by surgery as non-acute appendicitis, of which 7 patients had elevated serum total bilirubin and direct bilirubin, and 30 patients were normal. Conclusion: The increase of serum bilirubin level has certain clinical significance for the diagnosis of atypical acute appendicitis.

Higher Level of Serum Heme Oxygenase-1 in Patients With Intracerebral Hemorrhage

2015 ◽  
Vol 100 (7-8) ◽  
pp. 1220-1224 ◽  
Author(s):  
Xin Li ◽  
Changqing Li ◽  
Lichun Hou ◽  
Mei He ◽  
Guangfu Song ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Serum Level ◽  
Intracerebral Hemorrhage ◽  
Heme Oxygenase ◽  
Total Bilirubin ◽  
Direct Bilirubin ◽  
Control Group ◽  
Heme Oxygenase 1 ◽  
Serum Total Bilirubin ◽  
Significant Difference

The objective of this paper was to investigate the association of the serum level of heme oxygenase-1 in patients with intracerebral hemorrhage (ICH) with the risk of ICH. Heme oxygenase-1(HO-1) metabolizes heme into biliverdin, bilirubin, carbon monoxide, and iron, our recent study showed that serum level of HO-1 was increased in stroke patients, yet the association of HO-1 level with risk of intracerebral hemorrhage (ICH) is poorly known. Forty patients with ICH and another 40 patients without ICH were recruited. The serum level of HO-1, total, and direct bilirubin were measured. The level of HO-1, serum total bilirubin, and direct bilirubin, as well as blood pressure were increased in ICH group than in control group (P &lt; 0.001). The level of HO-1, both systolic and diastolic blood pressure had a significant difference between subgroups (P &lt; 0.05). Multivariate regression analysis showed that poor compliance to medicine for hypertension, the serum level of HO-1, and systolic blood pressure were associated with the prevalence of ICH. Blood pressure, serum HO-1, serum total bilirubin, and direct bilirubin were raised in patients with ICH who did not take medicine for hypertension compared with those who did, and increased in ICH patients in comparison with control group. Further investigation in multiple medical centers with large number of cohorts is warranted to verify these results.

scholarly journals SAT-572 Extremely Elevated Plasma Lipoprotein X Level Secondary to Alcoholic Cholestasis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carolyn Ann Nelson ◽  
Zahid Ahmad ◽  
Abhimanyu Garg
Keyword(s):  
Alkaline Phosphatase ◽  
Alcohol Consumption ◽  
Total Bilirubin ◽  
Serum Lipoprotein ◽  
Plasma Lipoprotein ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Gamma Glutamyl Transferase ◽  
Biliary Cirrhosis ◽  
Glutamyl Transferase

Abstract Background Marked elevations of plasma lipoprotein X (Lp-X) levels have been reported in patients with cholestasis due to primary biliary cirrhosis, pancreatic cancer, hepatitis C, and quetiapine. We now report a patient with extreme elevation of plasma Lp-X due to alcohol-induced cholestasis. Case Presentation A 44 year-old African American male presented with painless jaundice and fatigue for one week. He denied nausea, vomiting, diarrhea, change in stool or urine color, or weight loss. He consumes 720-1080 mL of beer (2-3 cans) every night and admitted to heavier alcohol consumption in the past. On physical examination he had scleral icterus and hepatomegaly but no xanthomas or xanthelasmas. His serum total cholesterol was 1,126 mg/dL (normal range, 120-199 mg/dL), triglycerides were 238 mg/dL (50-150 mg/dL), calculated LDL-cholesterol was 1,072 mg/dL (&lt;100 mg/dL), and HDL-cholesterol was 6 mg/dL (&gt;39 mg/dL). His serum AST, 162 IU/L (10-50 IU/L); ALT, 79 IU/L (10-50 IU/L); alkaline phosphatase, 1,058 IU/L (40-129 IU/L); total bilirubin, 18.8 mg/dL (0.2-1.3 mg/dL); direct bilirubin, 13.5 mg/dL (0-0.3 mg/dL); and gamma glutamyl transferase, 4,583 IU/L (8-61 IU/L) were markedly elevated. His blood alcohol level was 34 mg/dL (not detected), sodium 124 mmol/L (135-145 mmol/L), and platelet count was 84,000/µL (150,000-459,000/µL). His TSH 2.89 µIU/mL (0.4-4.5 µIU/mL), UA without proteinuria, HBV immunized, HCV negative, and anti-mitochondrial antibody negative. CT abdomen revealed hepatic steatosis and gallbladder swelling without evidence of obstruction. MRCP showed cirrhosis without primary sclerosing cholangitis. Serum lipoprotein electrophoresis confirmed the presence of Lp-X. On day 3 of hospitalization, his cholestasis improved and his serum total bilirubin 10.0 mg/dL, direct bilirubin 7.4 mg/dL, AST 108 IU/L, ALT 66 IU/L, and alkaline phosphatase 663 IU/L had improved. The patient was advised to abstain from all alcohol consumption. Telephone follow up 2 months later with his wife revealed that he had stopped drinking alcohol and that his jaundice had resolved. Conclusions Although alcohol-induced cholestasis is a well-recognized entity, such presentation with extreme elevations of Lp-X has not been previously reported. In such patients, it is important to establish whether extreme hypercholesterolemia is due to LDL or Lp-X since, as opposed to LDL, Lp-X elevations are not considered to be atherogenic.

scholarly journals Increased serum total bilirubin-albumin ratio was associated with bilirubin encephalopathy in neonates

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
Yan Wang ◽  
Guangyao Sheng ◽  
Lina Shi ◽  
Xiuyong Cheng
Keyword(s):  
Total Bilirubin ◽  
Direct Bilirubin ◽  
Control Group ◽  
Case Group ◽  
Serum Total Bilirubin ◽  
Natural Childbirth ◽  
Albumin Ratio ◽  
Indirect Bilirubin ◽  
Bilirubin Encephalopathy ◽  
Epidemiological Characteristics

Abstract We performed the present study to summarize the recent epidemiological characteristics of bilirubin encephalopathy and assess the role of total bilirubin-albumin ratio in the bilirubin encephalopathy. We retrospectively collected clinical data of 669 neonates with hyperbilirubinemia from the First Affiliated Hospital of Zhengzhou University between January 2015 and July 2018, including 153 neonates belonged to bilirubin encephalopathy and 516 ones were treated as control group. Compared with the control group, those with bilirubin encephalopathy have higher bilirubin-albumin ratio (13.8 ± 3.6 vs. 10.6 ± 2.5, P=0.000). The direct bilirubin and indirect bilirubin level were higher in the case group than that in the control group (P=0.000). On the contrary, the hemoglobin level was lower in the case group than that in the control group (P=0.004). There were no significant differences in gestational age (P=0.510), gender rate (P=0.313), maternal gestational diabetes ratio (P=0.071), natural childbirth ratio (P=0.686), and meconium delay (P=0.091). The results from univariate regression indicated the total bilirubin/albumin ratio was positively associated with bilirubin encephalopathy (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.59–3.14). The total bilirubin, direct bilirubin, and indirect bilirubin were also related to encephalopathy. After adjusting some potential cofounding factors, the total bilirubin-albumin was still associated with bilirubin encephalopathy. The higher total bilirubin-albumin ratio increased the risk of bilirubin encephalopathy by 23% (OR = 1.23, 95% CI: 1.16–2.48). Our results indicated that the bilirubin-albumin ratio is associated with bilirubin encephalopathy in neonates, and could be a potential predictor.

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods:  A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

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