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.

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 ◽  
Total Bilirubin ◽  
Correct Diagnosis ◽  
Total Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Control Groups ◽  
Diagnostic Dilemma ◽  
Laboratory Test Results ◽  
Laboratory Examinations ◽  
Pain Patients

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. Misdiagnoses, missed diagnoses, and inappropriate treatments are very common. Correct diagnosis mainly depends on the detection of a high urinary porphobilinogen (PBG) level, which is not a routine test performed in the clinic and highly relies on the physician’s awareness of AHP. Therefore, identifying a more convenient indicator for use during routine examinations is required to improve the diagnosis of AHP.Results: In the present study, we retrospectively analyzed laboratory examinations in 12 AHP patients and 100 patients with abdominal pain of other causes as the control groups between 2015 and 2021. Compared with the control groups, AHP patients showed a significantly higher urinary urobilinogen level during the urinalysis (P < 0.05). However, we showed that the higher urobilinogen level was caused by a false-positive result due to a higher level of urine PBG in the AHP patients. 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 when compared to the control groups. 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 screening marker for AHP in patients with abdominal pain.

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 Gastric Plexiform Fibromyxoma Arising in the Cardia in an Adolescent Male: A Rare Tumor with an Unusual Location

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Awrad Nasralla ◽  
Mufeed Alwabari ◽  
Osama Alsaif ◽  
Samir S. Amr
Keyword(s):  
Abdominal Pain ◽  
North America ◽  
Gastrointestinal Stromal Tumor ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Adolescent Male ◽  
Rare Tumor ◽  
Review Of The Literature ◽  
Unique Case

Plexiform fibromyxoma of the stomach, also known as plexiform angiomyxoid myofibroblastic tumor, is a rare benign gastric mesenchymal tumor, first described in 2007, which usually arises in the gastric antrum and affects adults. Few cases have been reported in children and adolescents. It can present with different clinical manifestations including abdominal pain, dyspepsia, hematemesis, and vomiting. Preoperatively, this tumor is usually diagnosed as gastrointestinal stromal tumor (GIST), and the correct diagnosis is made only after histopathological examination following surgical resection. Most cases were reported from East Asia (China, Japan, and Korea), North America, and Europe. We report herein a unique case of plexiform fibromyxoma, the first to be reported from the Middle East, arising in the cardia of the stomach in a 16-year-old adolescent male, with a brief review of the literature.

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 Disseminated Strongyloides Stercoralis Hyperinfection in An Immunocompetent Patient First Diagnosed by Metagenomic Next-Generation Sequencing in Cerebrospinal Fluid: A Case Report

2021 ◽  
Author(s):  
Junyan Qu ◽  
Zhiyong Zong
Keyword(s):  
Cerebrospinal Fluid ◽  
Abdominal Pain ◽  
Next Generation Sequencing ◽  
Clinical Manifestations ◽  
Good Health ◽  
Strongyloides Stercoralis ◽  
Next Generation ◽  
Diagnostic Dilemma ◽  
Disseminated Strongyloidiasis ◽  
Generation Sequencing

Abstract Background Disseminated Strongyloides stercoralis hyperinfection is rarely described in immunocompetent individuals and can lead to fatal outcomes if not recognized and diagnosed early. Non-specific clinical manifestations, such as pneumonia and gastroenteritis, pose a diagnostic dilemma. Case presentation: We report a case of a 67-year-old Chinese male who presented with two months of abdominal pain, fever, headache, vomiting, constipation, and slight cough with sputum. He had been in good health and had no history of glucocorticoid use. He was diagnosed with enterococcal meningitis and intestinal obstruction at a local hospital and improved after treatment with vancomycin, but symptoms of headache and abdominal pain soon recurred. The metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid using Illumina X10 sequencer revealed 7 sequence reads matching Strongyloides stercoralis. Disseminated strongyloidiasis was suspected. Next, microscopic examination of gastric fluid revealed Larvae of S. stercoralis. DNA extracted of larvae, the presence of both S. stercoralis ribosomal DNA gene and mitochondrial cytochrome c oxidase subunit 1 gene was identified. Disseminated strongyloidiasis was diagnosed. Albendazole (400 mg, twice daily) was used and the patient recovered gradually. Conclusions S. stercoralis hyperinfection can occur in immunocompetent individuals, imposing challenges for diagnosis. mNGS may be a useful tool for detecting rare infectious disease. The case would help clinicians to raise awareness of strongyloidiasis in non-endemic areas and reduce fatality.

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

Total bilirubin as a predictive marker for irinotecan-induced toxicity in patients with gastrointestinal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 68-68
Author(s):  
Katsuya Makihara ◽  
Sayaka Azuma ◽  
Hiroko Hasegawa ◽  
Masataka Ikeda ◽  
Kazumasa Fujitani ◽  
...  
Keyword(s):  
Gastrointestinal Cancer ◽  
Total Bilirubin ◽  
Total Bilirubin Level ◽  
Predictive Marker ◽  
Severe Neutropenia ◽  
Serum Total Bilirubin ◽  
Characteristic Analysis ◽  
Pre Treatment ◽  
Grade 3 ◽  
Experienced Grade

68 Background: Irinotecan (CPT-11) is widely used for the treatment of patients with gastrointestinal cancer. However, CPT-11 can cause severe neutropenia and diarrhea.It has been reported that the AUC of SN-38, an active metabolite of CPT-11, correlated with Pre-treatment serum total bilirubin level (PTB), but there is no criteria of dose setting based on the PTB. Therefore, we retrospectively searched the PTB which can serve as an indicator for dose setting of CPT-11. Methods: We investigated the incidence of neutropenia and diarrhea at the first 28 days in patients with gastrointestinal cancer who were administered CPT-11 alone in Osaka National Hospital from June 2006 to July 2013. Correlation between PTB and grade 3-4 neutropenia or diarrhea were assessed. When toxicity of correlation exists, ROC (receiver operating characteristic) analysis was conducted to explore the cut-off value of the PTB. In addition, the incidence of febrile neutropenia (FN) in the cut-off value was compared. Results: 87 patients were analyzed. Of these, 65 were gastric cancer, 22 were colorectal cancer. Although PTB was significantly higher in patients who experienced grade 3-4 neutropenia than those who didn’t (p<0.001), PTB was not associated with grade 3-4 diarrhea. As the results of ROC analysis, cut-off value of PTB associated with grade 3-4 neutropenia was determined to 0.8 mg/dL. The incidence of FN was significantly higher in 20% of patients with PTB ≥ 0.8 mg/dL compared with 1.6% of patients with PTB < 0.8 mg/dL (OR: 15.5, p=0.01). On the other hand, in subgroup analysis showed no difference in the incidence of FN and neutropenia in patients whose dose was less than 100 mg/m². Conclusions: PTB was a predictive marker for CPT-11-induced severe neutropenia and FN. Results of this study suggested needs of dose reduction to less than 100 mg/m2 in patients with PTB ≥ 0.8mg/dL.

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