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The evolution and clinical significance of abnormal liver chemistries and the impact of hepatitis B infection on outcome in patients with COVID-19 is not well characterized. This study aimed to explore these issues. This large retrospective cohort study included 2,073 patients with coronavirus disease 2019 (COVID-19) and definite outcomes in Wuhan, China. Longitudinal liver function tests were conducted, with associated factors and risk of death determined by multivariate regression analyses. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. The characteristics of liver abnormalities and outcomes of patients with COVID-19, with and without hepatitis B, were compared after 1:3 propensity score matching. Of the 2,073 patients, 1,282 (61.8%) had abnormal liver chemistries during hospitalization, and 297 (14.3%) had a liver injury. The mean levels of aspartate aminotransferase (AST) and direct bilirubin (D-Bil) increased early after symptom onset in deceased patients and showed disparity compared to levels in discharged patients throughout the clinical course of the disease. Abnormal AST (adjusted hazard ratio [HR] 1.39; 95% CI 1.04–1.86, p = 0.027) and D-Bil (adjusted HR 1.66; 95% CI 1.22–2.26; p = 0.001) levels at admission were independent risk factors for mortality due to COVID-19. A nomogram was established based on the results of multivariate analysis and showed sufficient discriminatory power and good consistency between the prediction and the observation. HBV infection in patients did not increase the risk of poor COVID-19-associated outcomes. Abnormal AST and D-Bil levels at admission were independent predictors of COVID-19-related mortality. Therefore, monitoring liver chemistries, especially AST and D-Bil levels, is necessary in hospitalized patients with COVID-19. Liver test abnormalities (in particular elevations in the levels of aspartate aminotransferase [AST] and direct bilirubin [D-Bil]) were observed after symptom onset in patients who went on to die of coronavirus disease 2019 (COVID-19). Abnormal levels of AST and D-Bil at admission were independent predictors of COVID-19-related mortality. HBV infection in patients did not increase the risk of poor COVID-19-associated outcomes. [Display omitted] • Levels of AST and D-Bil elevated early after the symptom onset in deceased patients and showed disparity compared with that in discharged patients throughout the clinical course of COVID-19. • Abnormal admission AST and D-Bil levels were independent predictors of COVID-19 mortality. • A novel nomogram was built based on admission AST and D-Bil levels as well as other baseline characteristics to predict the in-hospital mortality of COVID-19. • Hepatitis B infection was not found to be associated with the risk of lethal outcome in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Errors in laboratory medicine occur in the preanalytical, analytical, and postanalytical phases. The errors are mostly detected in the preanalytical period. However, analytical errors are still an important source of error, despite their frequency is reduced significantly in years thanks to developments in laboratories. In this case, an analytical error was noticed during the verification of a patient’s results. The direct bilirubin of a 66-year-old male patient admitted to the emergency department was higher than the total bilirubin. The patient’s symptoms were fatigue and dyspnoea. Albumin and haemoglobin (Hb) concentrations of the patient were significantly low. After considering the patient’s demographics and laboratory results, the laboratory specialist suspected a paraproteinemia interference. Total protein was performed as a reflective test. The albumin/globulin ratio was reversed. Thereafter, serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) were performed as another reflective tests, respectively. SPEP and IFE results were in favour of monoclonal gammopathy. The patient was directed to a haematologist, underwent a bone marrow biopsy, and the result was reported as Waldenstrom’s macroglobulinemia with plasma cell differentiation expressing IgM-Kappa. The patient went on a chemotherapy protocol, and his condition has been improved in subsequent months. Detection of analytical errors is of great importance, like in our case, and may be used as a tool to identify patients who have not yet been diagnosed. The laboratory specialist must dominate the entire process of each test in the laboratory, be aware of the limitations of tests, and turn these disadvantages into advantages when necessary. [ABSTRACT FROM AUTHOR]

BackgroundTo investigate characteristic clinical and imaging features and establish a scoring system for preoperative prediction of malignancy in the bulging duodenal papilla.MethodsA total of 147 patients with bulging duodenal papilla (Benign enlargement n = 67; malignant enlargement n = 80) from our hospital between 2010 and 2020 were retrospectively analyzed. We investigated meaningful clinical and CT imaging features and established the score model through logistic regression and weighted. The calibration test, the ROC, AUC, and cut-off points were performed in score model. The model was also divided into three score ranges for convenient clinical evaluation.ResultsThree clinical and CT imaging features were finally included in the score model including direct bilirubin (DBil) increase >7 umol/L (3 points), pancreatic duct (PD) dilation >5 mm (2 points), and irregular shape (2 points). The AUCs of the primary predictive model and score model were 0.896 (95% CI, 0.835–0.940) and 0.896 (95% CI, 0.835–0.940), respectively. This scoring system presented with a sensitivity of 78.8% and a specificity of 88.1% when using 2.5 points as cutoff value. Three score ranges were also proposed for convenient clinical use as follows: 0–2 points; 3–4 points; 5–7 points. The number of patients with malignant duodenal papillary enlargement increased with the increasing scores.ConclusionsWe proposed a convenient scoring system to preoperative predict malignancy in the bulging duodenal papilla.

In this study, we aimed to develop B. subtilis spore coat protein A (CotA) for the enzymatic determination of bilirubin. Firstly, molecular docking and oxidation kinetic analysis confirmed the feasibility of CotA for oxidizing bilirubin. Secondly, CotA showed pH-preferable oxidization performance to direct bilirubin (DB) in acidic conditions and an alkaline-catalytic oxidation capacity to total bilirubin (TB). Mechanism analysis results confirm that the conformational changes of CotA, DB and UB caused by pH changes are responsible for the selective oxidation of DB and TB by CotA. Then, CotA exhibits better structural characteristics and enzymatic performance than M. verrucaria -derived bilirubin oxidase (Mv -BOD). Besides, the strong anti-interference ability helps CotA adapt to complex catalytic environment in the detection of DB and TB. Our results prove that CotA can be used as a promising candidate bio-enzymatic detection reagent for DB and TB. Image 1 • CotA was applied as an enzymatic reagent for bilirubin detection. • CotA shows pH-selective oxidation ability to direct and total bilirubin. • CotA exhibits strong anti-interference ability to mental ions, Hb, Vc and chyle. • CotA showed better enzymatic properties than bilirubin oxidase. [ABSTRACT FROM AUTHOR]

Background: To investigate characteristic clinical and imaging features and establish a scoring system for preoperative prediction of malignancy in the bulging duodenal papilla. Methods: A total of 147 patients with bulging duodenal papilla (Benign enlargement n = 67; malignant enlargement n = 80) from our hospital between 2010 and 2020 were retrospectively analyzed. We investigated meaningful clinical and CT imaging features and established the score model through logistic regression and weighted. The calibration test, the ROC, AUC, and cut-off points were performed in score model. The model was also divided into three score ranges for convenient clinical evaluation. Results: Three clinical and CT imaging features were finally included in the score model including direct bilirubin (DBil) increase >7 umol/L (3 points), pancreatic duct (PD) dilation >5 mm (2 points), and irregular shape (2 points). The AUCs of the primary predictive model and score model were 0.896 (95% CI, 0.835–0.940) and 0.896 (95% CI, 0.835–0.940), respectively. This scoring system presented with a sensitivity of 78.8% and a specificity of 88.1% when using 2.5 points as cutoff value. Three score ranges were also proposed for convenient clinical use as follows: 0–2 points; 3–4 points; 5–7 points. The number of patients with malignant duodenal papillary enlargement increased with the increasing scores. Conclusions: We proposed a convenient scoring system to preoperative predict malignancy in the bulging duodenal papilla. [ABSTRACT FROM AUTHOR]

Analytical interferences (hemolysis, icterus, paraproteinemia, and lipemia) are of great concern in laboratory tests. In our case report, the conjugated bilirubin result of a patient was significantly higher than the total bilirubin. We recommend being more cautious with samples that produce indistinguishable results and attempting to resolve the issues before releasing them. [ABSTRACT FROM AUTHOR]

Paraproteins have been reported to cause interference in a sort of chemistry assays conducted by current automated chemistry analyzers. However, the nature of interference differs across different methodologies and reactions. Total bilirubin and direct bilirubin assays might yield spurious result when the sample contains excess amounts of paraproteins, which are neither reliable nor reproducible when repeated tests are applied once the interference occurs. Herein, we present the case of a 78-year-old female diagnosed with kappa light chain multiple myeloma with disease progression. On admission, she had acute hepatitis and a bizarre result with direct bilirubin level higher than total bilirubin level was noted. After further investigation, excess amounts of immunoglobulin G (IgG) were the most likely cause which led to the interference of direct bilirubin assay and caused unreliable results. This case highlights the significance of the fact that patients with excess IgG might have unreliable results of direct bilirubin assay which could mislead clinical judgment. Moreover, clinicians should be more careful and should base therapeutic decisions on the patient's clinical condition when faced with patients in a similar condition. [ABSTRACT FROM AUTHOR]

Background: Serum bilirubin and total bile acid (TBA) levels have been reported to be strongly associated with the risk and prognosis of certain cancers. Here, we aimed to investigate the effects of pretreatment levels of serum bilirubin and bile acids on the prognosis of patients with colorectal cancer (CRC).Methods: A retrospective cohort of 1474 patients with CRC who underwent surgical resection between January 2015 and December 2017 was included in the study. Survival analysis was used to evaluate the predictive value of pretreatment levels of bilirubin and bile acids. X-Tile software was used to identify optimal cut-off values for total bilirubin (TBIL), direct bilirubin (DBIL) and TBA in terms of overall survival (OS) and disease-free survival (DFS).Results: DBIL, TBIL, and TBA were validated as significant prognostic factors by univariate Cox regression analysis for both 3-year OS and DFS. Multivariate Cox regression analyses confirmed that high DBIL, TBIL and TBA levels were independent prognostic factors for both OS (HR: 0.435, 95% CI: 0.299-0.637, P < 0.001; HR: 0.436, 95% CI: 0.329-0.578, P < 0.001; HR: 0.206, 95% CI: 0.124-0.341, P < 0.001, respectively) and DFS (HR: 0.583, 95% CI: 0.391-0.871, P = 0.008; HR:0.437,95% CI: 0.292-0.655, P <0.001; HR: 0.634, 95% CI: 0.465-0.865, P = 0.004, respectively). In addition, nomograms for OS and DFS were established according to all significant factors, and the c-indexes were 0.819 (95% CI: 0.806-0.832) and 0.835 (95% CI: 0.822-0.849), respectively.Conclusions: TBIL, DBIL and TBA levels are independent prognostic factors in colorectal cancer patients. The nomograms based on OS and DFS can be used as a practical model for evaluating the prognosis of CRC patients. [ABSTRACT FROM AUTHOR]

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Introduction: An increasing number of cohort studies have shown a correlation between serum bilirubin and tumors, but no definitive causal relationship has been established between serum bilirubin and hematological malignancies.Therefore, the aim of the present study was to assess the causal relationship of serum bilirubin, including total bilirubin (TBIL) and direct bilirubin (DBIL), with hematological malignancies, including leukemia, lymphoma, and myeloma., Methods: We used a genome-wide association study (GWAS) collection of TBIL, DBIL, and hematological malignancies data. Using two-sample Mendelian randomization(MR), we assessed the impact of TBIL and DBIL on hematological malignancies. For this study, the inverse variance weighting method (IVW) was the primary method of MR analysis. In the sensitivity analysis, the weighted median method, MR Egger regression, and MR-PRESSO test were used. To understand the mechanisms behind TBIL and DBIL, we used three different approaches based on screening single nucleotide polymorphisms (SNPs) and their associated genes, followed by bioinformatics analysis., Results: The IVW test results showed evidence of effects of TBIL (odds ratio [OR]: 4.47, 95% confidence interval [CI]: 1.58-12.62) and DBIL (OR: 3.31, 95% CI: 1.08-10.18) on the risk of acute myeloid leukemia (AML).The findings from bioinformatics indicated that TBIL could potentially undergo xenobiotic metabolism through cytochrome P450 and contribute to chemical carcinogenesis., Discussion: In this study, two-sample MR analysis revealed a causal relationship between TBIL, DBIL, and AML., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lu, Luo, Li, Liu, Wu, Cai, Li, Huang, Chen, Zheng and Hu.)

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 (

Objective To investigate the changes and significance of serum γ-glutamyltranspeptidase (GGT) and direct bilirubin (DB) in children with biliary atresia and cholestasis. Methods Eighty children with biliary atresia (biliary atresia group) and 80 children with cholestasis (cholestasis group) were selected, and meanwhile, 50 healthy iufants were randomly chosen as the control group. The serum GGT and DB levels were detected by enzyme-linked immunosorbent assay. Pearson product moment correlation was used to analyze the correlation between serum GGT, DB and total bilirubin (TB), total bile acid (TBA), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Receiver operating characteristic (ROC) curve was drawn to evaluate the value of serum GGT and DB in the differential diagnosis of biliary atresia and cholestasis. Results Serum GGT, DB, TB, TBA, ALT, and AST in the biliary atresia group and choles tasis group were higher than those in the control group (all P < 0. 05), and the above indexes in the biliary atresia group were higher than those in the cholestasis group (all P < 0. 05). Pearson product moment correlation analysis showed that the serum GGT and DB were positively correlated with TB, TBA, ALT and AST in children with biliary atresia and cholestasis (all P < 0. 05). ROC curve analysis showed that serum GGT and DB had differential diagnosis value for biliary atresia and cholestasis, and the combined detection had higher differential diagnosis value, with the AUC of 0. 915 (95% CI : 0. 870 - 0. 945), the sensitivity, specificity, and accuracy of 91. 25%, 86. 25%, and 88. 75%, respectively. Conclusion Serum GGT and DB levels in children with biliary atresia and cholestasis increase, especially in children with biliary atresia; early combined detection can assist the clinical differential diagnosis of the two diseases. [ABSTRACT FROM AUTHOR]

We evaluated the relationship between serum bilirubin levels and ankle-brachial index (ABI) to determine whether gender affected the relationship between bilirubin levels and peripheral arterial disease (PAD) in patients with hypertension. A total of 543 patients were included in our studies (78 patients with PAD and 465 without PAD). Peripheral arterial disease was defined as ABI <0.90 for either and/or both sides. Serum bilirubin levels were measured with a vanadate oxidation method by using fasting venous blood samples. Serum total bilirubin (TBiL) and direct bilirubin (DBiL) levels were higher in males compared with females (both P <.05). Total bilirubin and DBiL were significantly lower in the PAD group. After adjustment for cardiovascular risk factors, PAD was independently negatively related to TBiL and DBiL, with odds ratios (OR) 0.914 (95% confidence interval [CI]: 0.845-0.990) and 0.748 (95% CI: 0.572-0.977). In addition, there was a relationship between PAD and bilirubin levels (TBiL—OR = 0.884, 95% CI: 0.792-0.985; DBiL—OR = 0.621; 95% CI: 0.424-0.909) only in males but not in females. Future studies should further evaluate whether interventions that increase serum bilirubin levels will have a particular role in PAD prevention in males. [ABSTRACT FROM AUTHOR]

Objective To study the value of serum gamma-glutamyl transpeptidase (GGT) combined with direct bilirubin (DB) in the diagnosis of biliary atresia. Methods A total of 667 infants with cholestasis who were hospitalized and treated from July 2010 to December 2018 were enrolled as subjects. According to the results of intraoperative cholangiography and follow-up, they were divided into biliary atresia group with 234 infants and cholestasis group with 433 infants. The two groups were compared in terms of age of onset, sex, and serum levels of total bilirubin (TB), DB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bile acid (TBA), and GGT. A receiver operating characteristic (ROC) curve analysis was performed for indices with statistical significance, and the area under the ROC curve (AUC) and the optimal cut-off value for diagnosis were calculated. Results The biliary atresia group had a significantly younger age of onset than the cholestasis group (P<0.001). There were no significant differences in sex, ALT, and AST between the two groups (P>0.05), while the biliary atresia group had significantly higher serum levels of TB, DB, TBA, and GGT than the cholestasis group (P<0.05). GGT combined with DB had the highest AUC of 0.892 (95% confidence interval: 0.868-0.916) in the diagnosis of biliary atresia. At the optimal cut-off values of 324.0 U/L for GGT and 115.1 μmmol/L for DB, GGT combined with DB had a sensitivity of 79.8% and a specificity of 83.2% in the diagnosis of biliary atresia. Conclusions GGT combined with DB has high sensitivity and specificity in the diagnosis of biliary atresia and can be used as an effective indicator for diagnosis of biliary atresia in infants. [ABSTRACT FROM AUTHOR]

Background: Abnormal liver function was frequently observed in nonalcoholic fatty liver disease (NAFLD) patients infected with SARS-CoV-2. Our aim was to explore the effect of SARS-CoV-2 inactivated vaccines on liver function abnormality among NAFLD patients with COVID-19., Methods: The multi-center retrospective cohort included 517 NAFLD patients with COVID-19 from 1 April to 30 June 2022. Participants who received 2 doses of the vaccine (n = 274) were propensity score matched (PSM) with 243 unvaccinated controls. The primary outcome was liver function abnormality and the secondary outcome was viral shedding duration. Logistic and Cox regression models were used to calculate the odds ratio (OR) and hazard ratio (HR) for the outcomes. Sensitivity analysis was conducted to assess robustness., Findings: PSM identified 171 pairs of vaccinated and unvaccinated patients. Liver function abnormality was less frequent in the vaccinated group (adjusted OR, 0.556 [95% CI (confidence interval), 0.356-0.869], p = 0.010). Additionally, the vaccinated group demonstrated a lower incidence of abnormal bilirubin levels (total bilirubin: adjusted OR, 0.223 [95% CI, 0.072-0.690], p = 0.009; direct bilirubin: adjusted OR, 0.175 [95% CI, 0.080-0.384], p < 0.001) and shorter viral shedding duration (adjusted HR, 0.798 [95% CI, 0.641-0.994], p = 0.044) than the unvaccinated group. Further subgroup analysis revealed similar results, while the sensitivity analyses indicated consistent findings., Interpretation: SARS-CoV-2 vaccination in patients with NAFLD may reduce the risk of liver dysfunction during COVID-19. Furthermore, vaccination demonstrated beneficial effects on viral shedding in the NAFLD population., Funding: 23XD1422700, Tszb2023-01, Zdzk2020-10, Zdxk2020-01, 2308085J27 and JLY20180124., Competing Interests: Declaration of interests The authors declare that they have no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Abnormal live function tests have been identified as independent risk factors for ominous prognosis in patients with heart failure. However, most of the previous studies have failed to determine the contribution of direct bilirubin (DBIL) and indirect bilirubin (IBIL) separately. Hence, we aimed to explore whether DBIL or IBIL is correlated with the prognosis of heart failure with preserved ejection fraction (HFpEF)., Methods: A total of 19837 patients were hospitalized for HFpEF between January 2012 and January 2022 in Fuqing City Hospital affiliated with Fujian Medical University. The primary endpoint was in-hospital all-cause mortality. Secondary endpoints included in-hospital cardiovascular mortality and 30-day re-admission for heart failure., Results: Univariable analysis indicated that patients with elevated DBIL or IBIL were exposed to a higher risk of mortality and re-admission. However, in multivariable models, both ln-transformed DBIL and TBIL, but not IBIL, were independent risk factors for in-hospital all-cause mortality (hazard ratio (HR)=1.796, 95% confidential interval (CI)=1.477-2.183, P<0.001; HR=1.854, 95% CI=1.461-2.352, P.0.001; HR=1.161, 95% CI=0.959-1.407, P=0.126) and in-hospital cardiovascular mortality (HR=1.831, 95% CI=1.345-2.492, P.0.001; HR=1.899, 95% CI=1.300-2.773, P=0.001; HR=1.145, 95% CI=0.841-1.561, P=0.389). Only DBIL remained independently associated with 30-day readmission for heart failure (HR=1.361, 95% CI=1.036-1.787, P=0.027). Adding ln-transformed DBIL to model 1 increased its discriminatory capacity (C-statistic: 0.851 to 0.869, respectively), whereas adding ln-transformed IBIL yielded little increment (C-statistic: 0.851 to 0.852, respectively)., Conclusion: DBIL, but not IBIL, was associated with short-term ominous prognosis in patients with HFpEF. Hence, DBIL may be the superior predictor for prognosis in HFpEF., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: To determine the frequency of Glucose-6-Phosphate dehydrogenase deficiency in neonates with hyperbilirubinemia and to find the association between level of G6PD deficiency and severity of hyperbilirubinemia. Study Design: Cross sectional Descriptive study Place and Duration: Hematology and Pediatrics Departments of Shaikh Zayed Hospital, Lahore from November 1st, 2012 to January 1st, 2014. Methodology: We included 100 neonates with hyperbilirubinemia after excluding the other risk factors. Initially screening for G6PD deficiency done with qualitative methods and deficient neonates were confirmed with quantitative method. History, examination and investigations like routine hematological investigations and total and direct bilirubin, Coomb's test, G6PD qua litative and quantitative assay were done in all subjects. Results: Out of 100 neonates 6% were G6PD deficient and in majority jaundice appeared on third day. For G6PD deficient neonates maternal age was found to be higher (29.83±1.17 years) as compared to that for normal G6PD neonates. Bilirubin was higher with a mean value of 24.48±7.0 mg/dl and platelets were lower in deficient group with a mean value of 166.33±58.64 x 109/L. Conclusion: In newborns presenting with neonatal jaundice, screening for G6PD deficiency should be considered. There is association between lower enzyme activity and hyperbilirubinemia, and an early recognition followed by treatment to avoid complications is advisable. [ABSTRACT FROM AUTHOR]

Objective To investigate the incidence of short-term adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). Methods Totally 122 STEMI patients undergoing emergency PCI were retrospectively analyzed. The mean follow-up period was 13.07 months. The occurrence of adverse cardiovascular events during the follow-up period was observed. The general clinical data, blood biochemical indices and interventional treatment were compared between the adverse cardiovascular events group and no-events group. Logistic regression analysis was used to analyze the risk factors of adverse cardiovascular events in patients with STEMI after emergency PCI. Results Forty cases had adverse cardiovascular events and 82 cases did not. The positive rate of smoking history, the proportion of cardiac function (> grade II) and the time from symptom to PCI in STEMI patients with adverse cardiovascular events were higher than those without (all P<0.05). Neutrophil/lymphocyte and direct bilirubin levels were higher in STEMI patients with adverse cardiovascular events than in those without, and total cholesterol levels were lower than those of patients without (all P < 0.05). The patients with adverse cardiovascular events had longer maximum stent length and more temporary pacemaker implantation than those without (all P<0.05). Logistic regression analysis showed that smoking history (OR = 2.63, 95% CI-. 1.02-6.76, P = 0.04) , cardiac function (> II) (OR = 3. 18, 95% Cl-. 1.20-8.43, P = 0.02), direct bilirubin (OP = 1.23, 95% CI: 1.02-6.76, P = 0.01) were the risk factors for adverse cardiovascular events in STEMI patients after emergency PCI. Conclusions Short-term adverse cardiovascular events occur in patients with STEMI after emergent PCI. Smoking history, cardiac function (> grade II) and high level of plasma direct bilirubin are risk factors for short-term adverse cardiovascular events in STEMI patients after emergency PCI. [ABSTRACT FROM AUTHOR]

Background and Aims: Bilirubin has antioxidant and anti-inflammatory properties; serum bilirubin levels have been known to be inversely associated with cardiovascular disease. However, the effects of different bilirubin subtypes on cardiometabolic traits are unknown. In this study, we aimed to determine whether direct bilirubin is more strongly correlated with small, dense low-density lipoprotein (sdLDL) compared to other bilirubin subtypes. We also investigated which LDL subfractions exhibited the highest correlation with direct bilirubin.Methods and Results: A total of 288 overweight and centrally obese women were included in this study. The Pearson correlation and Steiger's Z test were used to compare the correlation coefficients between bilirubin subtypes and lipoproteins. Multiple linear regression analyses were used to evaluate the independent association between direct bilirubin and mean LDL particle size. Only direct bilirubin levels were significantly associated with the sdLDL subfraction and mean LDL particle size. Mean LDL particle size exhibited a significantly stronger correlation with direct bilirubin than sdLDL, percent sdLDL, and the sdLDL:large LDL ratio. Regression analysis showed that direct bilirubin was significantly associated with mean LDL particle size, according to both the stepwise method (β = 11.445, P value = 0.002) and the enter method (β = 11.655, P value = 0.002).Conclusions: Direct bilirubin is more strongly correlated with the sdLDL subfraction compared with total and indirect bilirubin, and is independently associated with mean LDL particle size in overweight and centrally obese women. [ABSTRACT FROM AUTHOR]

Background We evaluated the prognostic value of serum bilirubin in advanced nasopharyngeal carcinoma (NPC) patients. Methods Seven-hundred fifty-nine advanced NPC patients treated with definitive chemoradiotherapy were retrospectively analyzed. Serum indirect bilirubin (IBIL) and direct bilirubin (DBIL) were measured before treatment. To evaluate different cutoff points for serum bilirubin, we utilized ROC curves. The Kaplan–Meier method and log-rank test were adopted to calculate and compare survival outcomes. Cox proportional hazard models were used to perform univariate and multivariate analyses. Results At 5 y, IBIL >7.15 μmol/l were significantly associated with superior progression-free survival (PFS, 83.6% vs 70.3%; P  < .001), overall survival (OS, 88.6% vs 80.5%; P  = .012), distant metastasis-free survival (DMFS, 90.3% vs 82.8%; P  = .006), and locoregional relapse-free survival (LRFS, 92.1% vs 86.4%; P  = .048) than IBIL ≤7.15 μmol/l. Similarly, patients with DBIL >2.65 μmol/l had better prognosis across all outcomes than those of patients with DBIL ≤2.65 μmol/l (all P  < .05), except no difference was observed in LRFS (90.5% vs. 87.3%, P  = .195). Multivariate analyses showed that IBIL >7.15 μmol/l was an independent protective prognostic factor for PFS (HR, 0.57; 95% CI, 0.40–0.81; P  = .002), OS (HR, 0.67; 95% CI, 0.43–0.92; P  = .041), and DMFS (HR, 0.63; 95% CI, 0.40–0.98; P  = .034); while serum DBIL only remained significant for PFS (HR, 0.63; 95% CI, 0.44–0.89; P  = .009). Conclusions Pretreatment IBIL and DBIL are potentially independent prognostic factors for patients with advanced NPC. [ABSTRACT FROM AUTHOR]

Background We occasionally encounter increases in direct bilirubin value on reanalysis of the surplus serum collected in the past from a neonate with indirect hyperbilirubinemia. But the details of this phenomenon are unclear. We evaluated the change of direct bilirubin and the relation of bilirubin photoisomer of the serum exposed to room light. Methods Surplus serum samples from neonates with indirect hyperbilirubinemia were exposed to room light for 24 h. The bilirubin fraction assay of samples was performed by the bilirubin oxidase method (Nescauto and Aqua-auto Kainos reagent) and high-performance liquid chromatography. Results Direct bilirubin increased significantly from 0.61 to 2.36 mg/dL. The respective ratios of bilirubin photoisomers before and after exposure were as follows: cyclobilirubin (0.007 to 0.29) and (EZ)-bilirubin (0.018 to 0.041) increased significantly, (ZZ)-bilirubin decreased 0.84 to 0.55 significantly. The difference of the cyclobilirubin concentration was most closely associated with those of the direct bilirubin concentration. Conclusion Direct bilirubin value was increased after exposure to the room light, and increase in direct bilirubin was significantly correlated by cyclobilirubin increase in the serum samples from neonates with indirect hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Early diagnosis followed by proper KP is essential for the improvement of long-term prognosis for patients with BA. It is increasingly accepted that KP at ≤ 30 days of age significantly improves native liver survival rate. Published analyses in English and Japanese indicate that screening by SCC and DB/CB is potentially feasible. Screening with SCC has been implemented in Tochigi Prefecture, Japan, since 1994. The concept of SCC was introduced from Japan to Taiwan and resulted in nationwide screening with SCC for the first time in Taiwan in 2004, followed by Japan in 2012. Home-based screening using SCC is easy and cost-effective; however, it may cause some difficulties for families in case of stools with intermediate colors. Laboratory-based screening using DB/CB may detect the suspected cases earlier, resulting in an increase in the number of patients with BA who undergo KP at ≤ 30 days of age; however, the recall rate is 1% and may be beyond an acceptable range. Further studies are needed to assess the feasibility and cost-effectiveness of both home-based (SCC) and laboratory-based (DB/CB) screening for BA. [ABSTRACT FROM AUTHOR]

Background: The direct bilirubin (D-Bil) assay on the AU Beckman Coulter instrumentation can be interfered by paraproteins, which may result in spurious D-Bil results. In a previous work, we took advantage of this fact to detect this interference, thus helping with the identification of patients with unsuspected monoclonal gammopathies. In this work, we investigate the possibility to detect interference based on the review of the photometric reactions, regardless of the D-Bil result. Methods: The D-Bil assay was carried out in a set of 2164 samples. It included a group of 164 samples with paraproteins (67 of which caused interference on the assay), as well as different groups of samples for which high absorbance background readings could also be expected (i.e. hemolyzed, lipemic, or icteric samples). Photometric reaction data were reviewed and receiver operating characteristics (ROC) curves were used to establish a cut-off for absorbance that best discriminates interference. Results: The best cut-off was 0.0100 for the absorbance at the first photometric point of the complementary wavelength in the blank cuvette. Once the optimal cut-off for probable interference was selected, all samples analyzed in our laboratory that provided absorbance values above this cut-off were further investigated to try to discover paraproteins. During a period of 6 months, we detected 44 samples containing paraproteins, five of which belonged to patients with non-diagnosed monoclonal gammopathies. Conclusions: Review of the photometric reaction data permits the systematic detection of paraprotein interference on the D-Bil AU assay, even for samples for which reasonable results are obtained. [ABSTRACT FROM AUTHOR]

The relationship between bilirubin levels and peripheral artery disease has been documented. Our aim was to demonstrate the possible relationship between serum bilirubin levels and abdominal aortic aneurysms (AAAs). The study included 219 patients, 110 had a previous diagnosis of AAA and 109 patients were normal controls. Only patients with AAAs which had a size of 40 to 54 mm were included in the study. Baseline laboratory values and 2 computerized tomographic measurements 12 months apart were recorded. Patients with AAA had significantly higher white blood cell (WBC) counts and neutrophil-lymphocyte ratio (NLR) but lower total and direct bilirubin levels compared with the control patients (P < .05). Multivariate logistic regression analysis showed that WBC, NLR, and total and direct bilirubin levels were independent predictors of the presence of an AAA (P = .03, P = .001, P = .001, and P = .001, respectively). White blood cells and total bilirubin level were independent predictors of a rapidly enlarging AAA (>10 mm/y, P = .002 and P < .001, respectively). This study demonstrated that increased WBC and decreased total bilirubin levels were independent predictors of an AAA, especially the subgroup in which the AAA was rapidly expanding. [ABSTRACT FROM AUTHOR]

Neonates with Down syndrome are at risk of developing transient abnormal myelopoiesis ( TAM), which is characterized by transient clonal myeloproliferation of the blast cells. TAM can resolve spontaneously, but some patients die at an early age due to organ failure. Liver fibrosis in TAM is a life-threatening condition, but treatment options have not yet been established. Here, we report on the case of an infant with TAM complicated by liver disease, whose hyperbilirubinemia was successfully ameliorated with omega-3 fatty acid (ω3 FA) lipid emulsion. Timely ω3 FA lipid emulsion may be a feasible treatment for liver disease in TAM before serious liver damage develops. [ABSTRACT FROM AUTHOR]

Introduction: While total bilirubin methods generally perform satisfactory across laboratories, there is perceived dissatisfaction over direct bilirubin results, particularly negative results in normal ranges, wide variation across labs and direct bilirubin results exceeding total bilirubin. Variation in reagent composition may be responsible for problems observed in direct bilirubin measurement performance. Method: This study was performed to see effect of various direct bilirubin reagents on observed values. 50 mmol/L, 150 mmol/L and 250 mmol/L HCL, water and saline are compared in the study. The study was done by modified Jendrassik diazo method using various composition of reagent R1 for direct bilirubin measurement. The study stratified results in various ranges. Saline and Water gives negative, constant, systemic bias as compared to 50mmol/L reagent for measurement of direct bilirubin. Result: On increasing HCL concentration in the reagent there is increasing negative, proportionate, systemic bias as compared to 50 mmol/L reagent for measurement of direct bilirubin. Discussion: Results of the study indicate need for better uniformity in reagents used for measurement of direct bilirubin to facilitate inter-laboratory comparison of patient result. [ABSTRACT FROM AUTHOR]