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Al Argan R, Alkhafaji D, Al Elq A, Albaker W, Elamin Y, Alwaheed A, Zeeshan M, AlElq Z, Alkhalifa M, Al Mansour R, Alghamdi S, Al Ghamdi A, Ismaeel F, Almarzouq A, Zainuddin F, AlSulaiman R. The association between serum ferritin and bilirubin with glycemic control among patients with type 2 diabetes mellitus. J Med Life 2023; 16:1670-1677. [PMID: 38406782 PMCID: PMC10893562 DOI: 10.25122/jml-2023-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 02/27/2024] Open
Abstract
Previous evidence has shown an association between serum ferritin and bilirubin levels in the development of type 2 diabetes mellitus (T2DM) and glycemic control. However, the evidence is scarce in Saudi Arabia. In this study, we aimed to evaluate the association between serum ferritin and bilirubin levels with glycemic control in patients with T2DM. This was a cross-sectional study that involved 153 patients with T2DM recruited from outpatient diabetes clinics. Participants were categorized into two groups: well-controlled and uncontrolled T2DM, based on their glycemic status. We focused on comparing the iron profile and bilirubin levels between these two groups and examining the influence of antidiabetic medications on these parameters. A total of 153 patients with T2DM were included (58.2% women and 41.8% men). In both univariate and multivariate analyses, ferritin levels did not have a statistically significant association with glycemic control. However, patients with well-controlled T2DM had a significantly higher median level of total bilirubin and direct bilirubin than those with uncontrolled T2DM. Only direct bilirubin showed a statistically significant association with FBG less than 130 mg/dl and HbA1c level less than 7.0%. Ferritin level was not associated with glycemic control in patients with T2DM. On the other hand, direct bilirubin level was an independent predictor of better glycemic control. Monitoring direct bilirubin levels could aid in predicting glycemic control in T2DM and could be a potential target for developing antidiabetic medications.
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Affiliation(s)
- Reem Al Argan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Dania Alkhafaji
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Abdulmohsen Al Elq
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Waleed Albaker
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Yasir Elamin
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Abrar Alwaheed
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Mohammad Zeeshan
- Department of Medical Education, College of Medicine, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Zainab AlElq
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Malak Alkhalifa
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Rana Al Mansour
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Shada Alghamdi
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Abdulelah Al Ghamdi
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Fatema Ismaeel
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Adnan Almarzouq
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Fatma Zainuddin
- Department of Medical Allied Services, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Reem AlSulaiman
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Khobar, Saudi Arabia
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Rafaqat S, Sattar A, Khalid A, Rafaqat S. Role of liver parameters in diabetes mellitus - a narrative review. Endocr Regul 2023; 57:200-220. [PMID: 37715985 DOI: 10.2478/enr-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
Diabetes mellitus is characterized by hyperglycemia and abnormalities in insulin secretion and function. This review article focuses on various liver parameters, including albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), alpha fetoprotein (AFP), alpha 1 antitrypsin (AAT), ammonia, bilirubin, bile acid, gamma-glutamyl transferase (GGT), immunoglobulin, lactate dehydrogenase (LDH), and total protein. These parameters play significant roles in the development of different types of diabetes such as type 1 diabetes (T1DM), type 2 diabetes (T2DM) and gestational diabetes (GDM). The article highlights that low albumin levels may indicate inflammation, while increased ALT and AST levels are associated with liver inflammation or injury, particularly in non-alcoholic fatty liver disease (NAFLD). Elevated ALP levels can be influenced by liver inflammation, biliary dysfunction, or bone metabolism changes. High bilirubin levels are independently linked to albuminuria in T1DM and an increased risk of T2DM. Elevated GGT levels are proposed as markers of oxidative stress and liver dysfunction in T2DM. In GDM, decreased serum AFP levels may indicate impaired embryo growth. Decreased AFP levels in T2DM can hinder the detection of hepatocellular carcinoma. Hyperammonemia can cause encephalopathy in diabetic ketoacidosis, and children with T1DM and attention deficit hyperactivity disorder often exhibit higher ammonia levels. T2DM disrupts the regulation of nitrogen-related metabolites, leading to increased blood ammonia levels. Bile acids affect glucose regulation by activating receptors on cell surfaces and nuclei, and changes in bile acid metabolism are observed in T2DM. Increased LDH activity reflects metabolic disturbances in glucose utilization and lactate production, contributing to diabetic complications. Poor glycemic management may be associated with elevated levels of IgA and IgG serum antibodies, and increased immunoglobulin levels are also associated with T2DM.
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Affiliation(s)
- Sana Rafaqat
- 1Department of Biotechnology, Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Aqsa Sattar
- 2Department of Zoology, Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Amber Khalid
- 3Department of Zoology, University of Narowal, Punjab, Pakistan
| | - Saira Rafaqat
- 2Department of Zoology, Lahore College for Women University, Lahore, Punjab, Pakistan
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Stec DE, Tiribelli C, Badmus OO, Hinds TD. Novel Function for Bilirubin as a Metabolic Signaling Molecule: Implications for Kidney Diseases. KIDNEY360 2022; 3:945-953. [PMID: 36128497 PMCID: PMC9438427 DOI: 10.34067/kid.0000062022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/24/2022] [Indexed: 01/30/2023]
Abstract
Bilirubin is the end product of the catabolism of heme via the heme oxygenase pathway. Heme oxygenase generates carbon monoxide (CO) and biliverdin from the breakdown of heme, and biliverdin is rapidly reduced to bilirubin by the enzyme biliverdin reductase (BVR). Bilirubin has long been thought of as a toxic product that is only relevant to health when blood levels are severely elevated, such as in clinical jaundice. The physiologic functions of bilirubin correlate with the growing body of evidence demonstrating the protective effects of serum bilirubin against cardiovascular and metabolic diseases. Although the correlative evidence suggests a protective effect of serum bilirubin against many diseases, the mechanism by which bilirubin offers protection against cardiovascular and metabolic diseases remains unanswered. We recently discovered a novel function for bilirubin as a signaling molecule capable of activating the peroxisome proliferator-activated receptor α (PPARα) transcription factor. This review summarizes the new finding of bilirubin as a signaling molecule and proposes several mechanisms by which this novel action of bilirubin may protect against cardiovascular and kidney diseases.
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Affiliation(s)
- David E. Stec
- Department of Physiology and Biophysics, Cardiorenal, and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Olufunto O. Badmus
- Department of Physiology and Biophysics, Cardiorenal, and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Terry D. Hinds
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky,Barnstable Brown Diabetes Center, University of Kentucky, Lexington, Kentucky,Markey Cancer Center, University of Kentucky, Lexington, Kentucky
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Bianco A, Tiribelli C, Bellarosa C. Translational Approach to the Protective Effect of Bilirubin in Diabetic Kidney Disease. Biomedicines 2022; 10:biomedicines10030696. [PMID: 35327498 PMCID: PMC8945513 DOI: 10.3390/biomedicines10030696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
Bilirubin has been regarded as a powerful endogenous antioxidant and anti-inflammatory molecule, able to act on cellular pathways as a hormone. Diabetic kidney disease (DKD) is a common chronic complication of diabetes, and it is the leading cause of end-stage renal disease. Here, we will review the clinical and molecular features of mild hyperbilirubinemia in DKD. The pathogenesis of DKD involves oxidative stress, inflammation, fibrosis, and apoptosis. Serum bilirubin levels are positively correlated with the levels of the antioxidative enzymes as superoxide dismutase, catalase, and glutathione peroxidase, while it is inversely correlated with C-reactive protein, TNF-α, interleukin (IL)-2, IL-6, and IL-10 release in diabetic kidney disease. Bilirubin downregulates NADPH oxidase, reduces the induction of pro-fibrotic factor HIF-1α expression, cleaved caspase-3, and cleaved PARP induction showing lower DNA fragmentation. Recent experimental and clinical studies have demonstrated its effects in the development and progression of renal diseases, pointing out that only very mild elevations of bilirubin concentrations result in real clinical benefits. Future controlled studies are needed to explore the precise role of bilirubin in the pathogenesis of DKD and to understand if the use of serum bilirubin levels as a marker of progression or therapeutic target in DKD is feasible and realistic.
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Affiliation(s)
- Annalisa Bianco
- Italian Liver Foundation (FIF), 34149 Trieste, Italy; (A.B.); (C.T.)
- National Research Council, Institute of Biomedical Technologies, Bari Unit, 70126 Bari, Italy
| | - Claudio Tiribelli
- Italian Liver Foundation (FIF), 34149 Trieste, Italy; (A.B.); (C.T.)
| | - Cristina Bellarosa
- Italian Liver Foundation (FIF), 34149 Trieste, Italy; (A.B.); (C.T.)
- Correspondence:
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Wei Y, Liu C, Lai F, Dong S, Chen H, Chen L, Shi L, Zhu F, Zhang C, Lv X, Peng S, Hao G. Associations between serum total bilirubin, obesity and type 2 diabetes. Diabetol Metab Syndr 2021; 13:143. [PMID: 34876211 PMCID: PMC8650363 DOI: 10.1186/s13098-021-00762-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to examine the cross-sectional association between serum total bilirubin (STB) and type 2 diabetes (T2D) risk in the general population, and whether obesity could moderate this association. METHODS We used data from the 1999-2018 National Health and Nutrition Examination Surveys (NHANES), including a total of 38,641 US adult participants who were 18 years or older. The STB was classified as the low, moderate, and high groups according to tertiles. RESULTS We found that participants with lower STB had a significantly higher risk of T2D than those with moderate (OR = 0.81; 95% CI 0.74, 0.89; P < 0.001) and high (OR = 0.65; 95% CI 0.59, 0.73; P < 0.001) STB. Also, a significant interaction between body mass index (BMI) and STB on T2D was observed (P < 0.001). Stratified analysis showed that low STB was associated with a 20% and 27% decrease of T2D risk for moderate and high STB groups in obese patients, however, these effect estimates were smaller in the population with lower BMI (< 30 kg/m2). Similar associations of STB with glycohemoglobin and insulin resistance were observed. CONCLUSION This study suggests that STB is associated with an elevated risk of T2D. More importantly, we reported for the first time that BMI may moderate the association between bilirubin and T2D.
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Affiliation(s)
- Yuan Wei
- Center for Scientific Research and Institute of Exercise and Health, Guangzhou Sport University, Guangzhou, 510500, China
| | - Chaoqun Liu
- Department of Nutrition, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Fangfang Lai
- Department of Pediatrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China
| | - Shan Dong
- Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, 510180, China
| | - Haiyan Chen
- Department of Endemic Disease, Guangzhou Center for Disease Control and Prevention, Guangzhou, 510632, China
| | - Li Chen
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Liping Shi
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Fengfeng Zhu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Chuangbiao Zhang
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiuxiu Lv
- Department of Pathophysiology, School of Medicine, Jinan University, 601 Huangpu Avenue West, Guangzhou, 510632, Guangdong, China.
| | - Shuang Peng
- Department of Pathophysiology, School of Medicine, Jinan University, 601 Huangpu Avenue West, Guangzhou, 510632, Guangdong, China.
| | - Guang Hao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 West Huangpu Ave, Guangzhou, 510632, Guangdong, China.
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Xie J, Zhang Z, Liang Y, Yang Z. Decreased Bilirubin is Associated With Disease Activity of Primary Sjögren's Syndrome. Arch Rheumatol 2021; 35:351-356. [PMID: 33458658 PMCID: PMC7788656 DOI: 10.46497/archrheumatol.2020.7633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/04/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to determine the serum bilirubin levels in primary Sjögren's syndrome (pSS) patients and to explore clinical significance of bilirubin in pSS. Patients and methods Retrospective analysis of electronic medical records was performed in 97 pSS patients (12 males, 85 females; mean age 54±15 years; range, 15 to 91 years) and 100 healthy controls (17 males, 83 females; mean age 51±14 years; range, 25 to 75 years). Serum bilirubin and other variables were compared between pSS patients and healthy controls. The European League Against Rheumatism Sjögren's syndrome disease activity index (ESSDAI) was used to assess the disease activity of pSS, and ESSDAI ≥5 was defined as moderate to high activity. The relationship between bilirubin and ESSDAI was analyzed by Spearman's correlation analysis and multivariable logistic regression. Results The median level of serum bilirubin was 9 μmol/L (interquartile range (IQR), 7-13 μmol/L) in pSS patients, much lower than healthy controls (median, IQR, 13, 10-18 μmol/L) (p<0.001). It was positively correlated with age (r=0.255, p=0.012), but negatively with immunoglobulin (Ig) A (r=-0.314, p=0.003), IgG (r=-0.265, p=0.015), erythrocyte sedimentation rate (r=-0.309, p=0.002) and ESSDAI (r=-0.342, p=0.001). Multivariate analysis revealed that increased bilirubin was independently associated with decreased risk of moderate to high disease activity (odds ratio, 95% confidence interval: 0.852, 0.730-0.955). Conclusion Serum bilirubin is decreased in pSS patients and may be a useful biomarker for reflecting pSS disease activity.
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Affiliation(s)
- Jing Xie
- Department of Laboratory Medicine,Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, China
| | - Zhencheng Zhang
- Department of Laboratory Medicine,Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, China
| | - Yan Liang
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zaixing Yang
- Department of Laboratory Medicine,Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, China
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Hinds TD, Stec DE. Bilirubin Safeguards Cardiorenal and Metabolic Diseases: a Protective Role in Health. Curr Hypertens Rep 2019; 21:87. [PMID: 31599366 DOI: 10.1007/s11906-019-0994-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To discuss recent advances indicating that bilirubin safeguards against cardiorenal and metabolic diseases. RECENT FINDINGS Several investigations from human patient populations and experimental animal models have shown that bilirubin improves cardiorenal and metabolic dysfunction. The latest studies found an entirely new function of bilirubin suggesting that it acts as a hormone signaling molecule capable of activating nuclear receptors for burning fat, which may explain several of its protective actions. This review highlights the current findings (within the last 3 years) regarding cardiorenal and metabolic protective effects of bilirubin and the latest mechanism(s) that may be mediating these effects.
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Affiliation(s)
- Terry D Hinds
- Department of Physiology and Pharmacology, University of Toledo College of Medicine, Toledo, OH, 43614, USA
| | - David E Stec
- Department of Physiology & Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State St, Jackson, MS, 39216, USA.
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Yao Q, Jiang X, Kou L, Samuriwo AT, Xu HL, Zhao YZ. Pharmacological actions and therapeutic potentials of bilirubin in islet transplantation for the treatment of diabetes. Pharmacol Res 2019; 145:104256. [PMID: 31054312 DOI: 10.1016/j.phrs.2019.104256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/27/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022]
Abstract
Islet transplantation is the experimental strategy to treat type 1 diabetes by transplanting isolated islets from a donor pancreas into the recipient. While significant progress has been made in the islet transplantation field, islet loss before and after transplantation is still the major obstacle that currently precludes its widespread application. Islet must survive from possible cellular damages during the isolation procedure, storage time, islet injection process and post-transplantation immune rejection, only then the survived islets could produce insulin, actively regulating the blood glucose level. Therefore, islet protection needs to be addressed, especially regarding oxidative stress and immune response induced islet cell damages in diabetic patients. Many clinical data have shown that mildly elevated bilirubin levels in the body negatively correlate to the occurrence of an array of diseases that are related to increased oxidative stress, especially diabetes, and its complications. Recent studies confirmed that bilirubin helps receivers to suppress immune reaction and enable prolonged tolerance to islet transplantation. In this paper, we will review the pharmacological mechanism of bilirubin to modulate oxidative cellular damage and chronic inflammatory reaction in both diabetes and islet transplantation process. Also, we will present the clinical evidence of a strong correlation in bilirubin and diabetes. More importantly, we will summarize undergoing therapeutic applications of bilirubin in islet transplantation and discuss formulation approaches designed to overcome bilirubin delivery issues for future use.
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Affiliation(s)
- Qing Yao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China.
| | - Xue Jiang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Longfa Kou
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Adelaide T Samuriwo
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - He-Lin Xu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Ying-Zheng Zhao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China.
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Ozeki M, Morita H, Miyamura M, Fujisaka T, Fujita SI, Ito T, Shibata K, Tanaka S, Sohmiya K, Hoshiga M, Ishizaka N. High serum bilirubin is associated with lower prevalence of peripheral arterial disease among cardiac patients. Clin Chim Acta 2018; 476:60-66. [DOI: 10.1016/j.cca.2017.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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