Measurement and clinical usefulness of bilirubin in liver disease

Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of heart failure cases, with increasing prevalence due to aging and risk factors such as hypertension and obesity. Liver dysfunction is common in HFpEF and may impact prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic value of liver function markers (albumin, bilirubin, AST, ALT, ALP) in HFpEF patients.

METHODS

A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted for studies assessing the association of liver markers with adverse outcomes in HFpEF. The primary outcome was a composite of heart failure-related hospitalization or death. Hazard ratios (HR) were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic.

RESULTS

Twenty studies involving 30,623 patients were included. Serum albumin, the main marker of our study, was significantly associated with a reduced risk of adverse outcomes in a meta-analysis of 16 studies (HR 0.71, 95% CI: 0.61-0.83; I² = 87%). After excluding outliers, heterogeneity decreased (I² = 23%), and the association remained significant (HR 0.75, 95% CI: 0.69-0.82). Although no significant associations were found for AST, ALT, ALP, or bilirubin with adverse outcomes, the limited number of studies for these markers may have contributed to the lack of statistical significance.

CONCLUSION

Higher serum albumin levels predict better outcomes in HFpEF, while other liver function markers showed limited prognostic utility. Serum albumin may serve as a valuable marker for risk stratification in HFpEF.

Evaluation of hepatoprotective and nephroprotective activities of Castanopsis costata extract in rats

The liver and kidneys are important organs for body homeostasis but susceptible to damage or injury caused by different factors. A number of medicinal plants, such as Castanopsis costata have been proven effective in protecting the liver and kidneys from damage. Therefore, the present study aimed to examine the effect of C. costata extract (CcE) on paracetamol-induced hepatotoxicity and gentamicin-induced nephrotoxicity in rat model. Each treatment group was given CcE at doses of 100, 200 and 400 mg/kg for 21 and 8 days for hepatoprotective tests and nephroprotective tests, respectively. To induce liver and kidney damage, rats were given paracetamol 1,000 mg/kg orally for 7 (15-21) and gentamicin 80 mg/kg intraperitoneally for 5 (4-8) days. To assess liver function, the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TB), total cholesterol (TC), total albumin (TA) and total protein (TP) were measured, as well as liver antioxidant enzymes. Meanwhile, to assess kidney function, the levels of serum creatinine (SCr), serum urea (SU) and uric acid (UA) were measured. TNF-α and IFN-γ were also measured with histopathology testing to assess the effects of liver and kidney organ damage in each experiment. The results showed that CcE reduced the levels of AST, ALT, ALP, TB and TC, increased TA, TP and liver antioxidant enzymes, as well as reducing SCr, SU and UA when compared with the pathological group. Additionally, CcE reduced the levels of TNF-α and IFN-γ, as well as improving the structure of liver and kidney tissue as confirmed by histopathology. CcE had hepatoprotective and nephroprotective effects on paracetamol-induced and gentamicin-induced rats, respectively.

The CYP4/20-HETE/GPR75 axis in the progression metabolic dysfunction-associated steatosis liver disease (MASLD) to chronic liver disease

Introduction

Metabolic-dysfunction-associated steatosis liver disease (MASLD) is a progressive liver disease from simple steatosis, steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Chronic liver diseases (CLDs) can lead to portal hypertension, which is a major cause of complications of cirrhosis. CLDs cause structural alterations across the liver through increased contents of extracellular matrix (ECM), driving dysfunction of liver sinusoidal endothelial cells (LSECs) alongside hepatic stellate cells (HSCs) and activated resident or infiltrating immune cells. Bioactive arachidonic metabolites have diverse roles in the progression of MASLD. Both secreted levels of 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acid (EET) are elevated in patients with liver cirrhosis.

Methods

CLD samples were evaluated for changes in free fatty acids (FFA), cholesterol, bilirubin, bile acid, reactive oxygen species (ROD), lipid peroxidation, myeloperoxidase activity and hydroxyproline levels to evaluate the degrees of liver damage and fibrosis. To address the role of the CYP4/20-HETE/GPR75 axis, we measured the amount and the synthesis of 20-HETE in patients with CLD, specifically during the progression of MASLD. Additionally, we evaluated gene expression and protein levels of GPR75, a high-affinity receptor for 20-HETE across CLD patient samples.

Results

We observed an increase in 20-HETE levels and synthesis during the progression of MASLD. Increased synthesis of 20-HETE correlated with the expression of CYP4A11 genes but not CYP4F2. These results were confirmed by increased P4504A11 protein levels and decreased P4504F2 protein levels during the development and progression of MASLD. The gene expression and protein levels of GPR75, the major receptor for 20-HETE, increased in the progression of MASLD. Interestingly, the CYP4A11 and GPR75 mRNA levels increased in steatohepatitis but dramatically dropped in cirrhosis and then increased in patients with HCC. Also, protein levels of P4504A11 and GPR75 mirrored their mRNA levels.

Discussion

These results indicate that the CYP4A11 and subsequent GPR75 genes are coordinately regulated in the progression of MASLD and may have multiple roles, including 20-HETE activation of peroxisome proliferator-activated receptor α (PPARα) in steatosis and GPR75 in CLD through either increased cell proliferation or vasoconstriction in portal hypertension during cirrhosis. The abrupt reduction in CYP4A11 and GPR75 in patients with cirrhosis may also be due to increased 20-HETE, serving as a feedback mechanism via GPR75, leading to reduced CYP4A11 and GPR75 gene expression. This work illustrates key correlations associated with the CYP4/20-HETE/GPR75 axis and the progression of liver disease in humans.

Deciphering of differences in gut microbiota and plasma metabolites profile between non-obese and obese Golden Retrievers dogs

Introduction

Golden Retrievers have a high risk of obesity, which is prevalent in dogs and is associated with inflammation and cancer, impairing the health and life expectancy of companion animals. Microbial and metabolite biomarkers have been proposed for identifying the presence of obesity in humans and rodents. However, the effects of obesity on the microbiome and metabolome of Golden Retrievers remains unknown. Therefore, this study was designed to evaluate the signatures of serum biochemistry indexes, gut microbiota and plasma metabolites in non-obese and obese Golden Retrievers, aiming to recognize potential biomarkers of canine obesity.

Methods

A total of 8 non-obese (Ctrl group) and 8 obese (Obe group) Golden Retrievers were included in the present study to collect blood and feces samples for measurements. The fecal microbiome and plasma metabolome were determined using 16S rRNA amplicon sequencing and liquid chromatography-mass spectrometry, respectively.

Results

Results showed that the alanine aminotransferase activity and total bilirubin concentration, which have been measured using serum biochemistry analysis, were higher in the Obe group than in the Ctrl group (p < 0.05). Moreover, there was a significant difference in gut microbiota composition between the two groups (p < 0.05). The phyla Proteobacteria, Fusobacteriota, and Bacteroidota as well as genera Fusobacterium, Prevotella, Faecalibacterium, Escherichia-Shigell, and Alloprevotella were more abundant, while phylum Firmicutes and genera Peptoclostridium, Blautia, Turicibacter, Allobaculum, and Erysipelatoclostridium were less abundant in the Obe group compared to the Ctrl group (p < 0.05). Plasma concentrations of citrulline and 11-dehydrocorticosterone were significantly higher in the Obe group than those in the Ctrl group (p < 0.05). Close correlations between serum biochemistry parameters, gut microbiome, and plasma metabolites were observed in the current study.

Conclusion

The obesity-induced shifts in serum biochemistry indexes, gut microbiota, and plasma metabolites profiles suggest that obese Golden Retrievers exhibit a different microbiome and metabolome than non-obese ones, and the certain metabolites like citrulline and 11-dehydrocorticosterone could be considered as potential biomarkers to recognize obese Golden Retrievers.

Beyond the virus: ecotoxicological and reproductive impacts of SARS-CoV-2 lysate protein in C57Bl/6j female mice

Since the establishment of the COVID-19 pandemic, a range of studies have been developed to understand the pathogenesis of SARS-CoV-2 infection, vaccine development, and therapeutic testing. However, the possible impacts that these viruses can have on non-target organisms have been explored little, and our knowledge of the consequences of the COVID-19 pandemic for biota is still very limited. Thus, the current study aimed to address this knowledge gap by evaluating the possible impacts of oral exposure of C57Bl/6 J female mice to SARS-CoV-2 lysate protein (at 20 µg/L) for 30 days, using multiple methods, including behavioral assessments, biochemical analyses, and histopathological examinations. Although we did not have evidence of hematological, mutagenic, or genotoxic effects, we noted that the ingestion of SARS-CoV-2 lysate protein-induced behavioral disorders (hypoactivity, anxiety-like behavior, and short-term memory deficit), which were associated with oxidative stress and dopaminergic and cholinesterase imbalance in the animal brain. Furthermore, the elevation of bilirubin levels and lactate dehydrogenase levels in these animals suggests the occurrence of hepatic changes, and the redox imbalance, nitrosative stress, and elevated production of IFN-γ and inflammatory infiltration in the duodenum, disrupted follicular structure, and presence of vacuoles in granulosa cells, in ovarian, indicate that the SARS-CoV-2-exposed group showed significant toxicity. Principal component analysis (PCA) and cluster analysis confirmed that the groups were clearly separated and showed that the largest changes upon SARS-CoV-2 exposure were related to ROS, MDA, nitrite, IFN-γ/IL-10 levels and SOD and catalase activity in the ovary; IFN-γ/IL-10 production and SOD activity in the duodenum; BChE activity in the brain; bilirubin levels and lactate dehydrogenase activity in the serum; number of primary follicles in the ovary. In conclusion, our study provides new insights into the toxicity of SARS-CoV-2 lysate proteins in a non-target terrestrial organism of infection and, therefore, expands our understanding of the real extent of the ecological/environmental impact of the COVID-19 pandemic.

Electrolyte imbalance and liver function test abnormalities among pregnant women with hyperemesis gravidarum at Wag-himra zone public hospitals, Northeast Ethiopia, 2023: a comparative cross-sectional study

Background

Hyperemesis gravidarum affects about 4.8% of pregnant women. It can lead to electrolyte imbalances and liver function disturbances, which may result in pregnancy complications. Despite its prevalence, data on these abnormalities in the study area is scarce. Therefore, the current study investigated these health concerns among HG-affected pregnant women in this region from June to October 2023.

Method

A comparative cross-sectional study was conducted on 123 study participants. Socio-demographic, clinical, and anthropometric data were collected using structured questionnaires. Blood samples were taken to determine liver function tests and electrolyte levels. Statistical analysis was performed using a one-way ANOVA with a Tuckey post hoc test, Kruskal-Wallis with a Mann-Whitney U test, and binary logistic regression analysis. A p-value of <0.05 with 95% confidence intervals was considered statistically significant.

Results

The results showed that pregnant women with hyperemesis gravidarum had significantly higher levels of AST and ALT and lower levels of Na+ and K+ compared to normal pregnant women and non-pregnant women. The abnormalities observed were elevated AST (48.8%), ALT (46.3%), and decreased Na+ (51.2%) and K+ (41.5%). Hyperemesis gravidarum was associated with both electrolyte imbalances and liver function test abnormalities.

Conclusion

Pregnant women with hyperemesis gravidarum experience electrolyte imbalances and liver function test abnormalities. Given the marked increase in liver enzymes and decrease in electrolyte levels, the authors recommend routine laboratory testing of liver function and electrolyte parameters for pregnant women with hyperemesis gravidarum is recommended.

Evolution of Hematobiochemical Profiles in Newly Diagnosed HIV Patients and HIV-TB Co-Infected Patients: Correlation with Immunological and Virological Status

Background

CD4+ cells, HIV-1 plasma viral load (PVL), and IFN-γ have been observed to enhance susceptibility in TB infection/reactivation among HIV-1 infected people, leading to unusual clinical manifestations. HIV-TB co-infection is significant for immunological and virological response, making it a great clinical challenge for patient management. The objective of this study was to explore the correlation among various hematological and biochemical profiles with CD4+ count and PVL in order to decipher mechanisms of TB development or reactivation in HIV-infected patients.

Methods

In this cross-sectional study, we included 200 newly diagnosed treatment naïve HIV-1 infected patients, of which 118 were HIV-TB co-infected and 82 were HIV-alone. The CD4+ T count was determined using the BD FACS Count System, and the plasma HIV-1 viral load was estimated using the Abbott m2000 real-time platform. The hematobiochemical testing was performed on fully-automated analyzer ADVIA® 560 and Cobas® 501 Roche Diagnostics. Statistical software SPSS-2, Spearman correlation analysis was used for data analysis and a P-value less than 0.05 was considered statistically significant.

Results

Declined hemoglobulin level positively correlated with CD4 counts (r = 0.229; p = 0.001), and a negative correlation was observed with HIV-1 plasma viral load (r = -0.171; p = 0.016). Moreover, the CD4+ count and HIV-1 plasma viral load (PVL) were also correlated to anomalies such as thrombocytopenia, leucopenia, eosinophils, neutrophils, ESR, potassium, Albumin, globulin, SGOT, uric acid. Studies also found significantly higher absolute neutrophil count, ESR, and serum fasting blood sugar, creatine, uric acid, total bilirubin, globulin, and alkaline phosphatase in HIV-TB co-infected patients.

Conclusion and Recommendation

The initial value of Hb, ESR, absolute neutrophil counts, serum calcium, uric acid, and potassium can be used as an early indicator for active tuberculosis (TB) and as a substitute marker for the course of HIV disease, especially in areas with low resources.

The Multifaceted Role of Bilirubin in Liver Disease: A Literature Review

Bilirubin, the primary breakdown product of hemoproteins, particularly hemoglobin, plays a key role in the diagnosis, prognosis, and monitoring of liver diseases. In acute liver diseases, such as acute liver failure, drug-induced liver injury, and viral hepatitis, bilirubin serves as a biomarker reflecting the extent of hepatocyte loss and liver damage. Chronic liver diseases, including alcohol-related liver disease, chronic hepatitis C virus infection, metabolic dysfunction-associated fatty liver disease, and autoimmune liver diseases, are marked by persistent liver injury and inflammation. Bilirubin levels in chronic liver diseases provide insight into liver function, disease severity, and prognosis. As a versatile biomarker, bilirubin offers valuable information on the pathophysiology of liver diseases and aids in guiding clinical decision-making regarding the treatment of liver diseases and their complications. This review aimed to explore the multifunctional role of bilirubin in liver diseases by analyzing its biological functions beyond its role as a biomarker of liver damage.

Elevated serum direct bilirubin is predictive of a poor prognosis for primary myelodysplastic syndrome

BACKGROUND

The aim of this study was to assess the prognostic significance of serum direct bilirubin (DBIL) for patients newly diagnosed with myelodysplastic syndromes (MDS).

METHODS

The clinical, laboratory, and follow-up data of MDS patients were collected, and the associations of DBIL levels with overall survival (OS) and leukemia-free survival (LFS) were analyzed.

RESULT

In total, 262 MDS patients were assigned to the high DBIL level group or the normal DBIL level group in the retrospective study. High DBIL was associated with older age, reduced hemoglobin, higher levels of β2-microglobin, lactate dehydrogenase, and serum ferritin, along with the number of co-mutations (> 1) and a higher frequency of ASXL1, KIT, and KRAS mutations. Multivariate analyses found that high DBIL level was an independent adverse predictor for OS (p = 0.002, hazard ratio = 2.723, 95%CI = 1.442-5.143) but not for LFS (p = 0.057, hazard ratio = 1.678, 95%CI = 0.986-2.857). A novel nomogram based on DBIL, sex, age, β2-microglobulin, lactate dehydrogenase, the Revised International Prognostic Scoring System (IPSS-R) was constructed, which demonstrated superior accuracy compared with the IPSS-R (C-index, 0.790 vs. 0.731, respectively).

CONCLUSION

An elevated DBIL level was identified as an independent adverse prognostic factor for MDS patients. An individualized prediction model was established and validated to improve prediction of OS and LFS.

Serum bilirubin levels and risk of colorectal cancer in Korean adults: results from the Korean Genome and Epidemiology Study-Health Examinee (KoGES-HEXA) Cohort Study

BACKGROUND

Current evidence on associations between circulating bilirubin and colorectal cancer (CRC) risk is inconsistent.

METHODS

In this prospective study, we investigated associations of pre-diagnostic circulating levels of total and indirect bilirubin with CRC risk in 78,467 Korean adults aged 40-78 years at recruitment, considering potential non-linearity and sex differences. Hazard ratios (HR) and 95% confidence intervals (CI) for associations with CRC risk were estimated with Cox proportional hazard regression.

RESULTS

During a median 7.9-year follow-up, 539 incident CRC cases were recorded. In multivariable-adjusted models, higher levels of total bilirubin were associated with a 26% (CI: 42% to 7%) lower risk of CRC among men and women combined, comparing the highest with the lowest tertile (P-linear trend = 0.003). A U-shaped association was observed in men, with the lowest risk at approximately 0.8 mg/dL (=13.7 μmol/L) of total bilirubin (P for non-linearity = 0.01). Although the association was largely null in women, there was no evidence for effect modification by sex (P-interaction = 0.73). Associations between indirect bilirubin and CRC risk were similar.

CONCLUSIONS

Higher circulating levels of total and indirect bilirubin were inversely associated with the risk of CRC among Korean adults. The associations were strongly inverse and U-shaped among men.

The association between bilirubin concentrations and inflammatory bowel disease: Insights from a systematic review and meta-analysis

BACKGROUND

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), poses a significant challenge to health care systems because of its chronic nature and increasing global prevalence. Effective management of IBD requires accurate diagnostic tools and biomarkers. This systematic review and meta-analysis aimed to evaluate the relationship between bilirubin concentrations and IBD activity and outcomes.

METHODS

A comprehensive search of electronic databases identified 11 studies that included 2606 subjects with IBD and 3607 healthy controls.

RESULTS

Bilirubin concentrations were significantly lower in subjects with IBD when compared to controls (SMD = -0.96, 95% CI -1.21 to -0.70; p < .001). Although substantial heterogeneity was observed, sensitivity analysis confirmed the robustness of the results. Publication bias was detected, but subgroup analyses did not significantly alter the results. Meta-regression showed that age was a significant factor influencing the association between bilirubin concentrations and IBD. Subgroup analyses showed a more pronounced reduction in bilirubin concentrations in subjects with CD than those with UC.

CONCLUSION

This study supports the potential utility of bilirubin as a biomarker in IBD, emphasizing the need for further research to validate its clinical significance.

Harmony in nature's elixir: a comprehensive exploration of ethanol and nano-formulated extracts from Passiflora incarnata leaves: unveiling in vitro cytotoxicity, acute and sub-acute toxicity profiles in Swiss albino mice

We analyzed the toxic effect of the ethanolic extract of Passiflora incarnata (EEP) and its nanoformulation (N-EEP) in the in vitro and in vivo models (zebrafish embryos and Swiss albino mice). The EEP composition was verified by phytochemical and GC-MS analysis. The synthesized N-EEP was characterized using UV-visible spectroscopy and scanning electron microscopy. In vitro results showed both EEP and N-EEP have a dose-dependent effect in L132 cells (normal embryonic lung cells). In zebrafish embryos, no developmental changes were observed for both EEP and N-EEP at 200 µg/ml. The acute and sub-acute toxicity of EEP and N-EEP was identified by oral administration in Swiss albino mice. A single-day oral dose of EEP and N-EEP at different concentrations was administered for acute toxicity, and changes in body weight, food, water intake, temperature, respiration rate, skin color changes, and eye color till 72 h was observed. In a sub-acute toxicity study, 28 days oral administration of different concentrations of EEP and N-EEP was done. Hematological analysis, serum hepatic biochemical parameter analysis, and histopathological analysis for the liver, kidney, spleen, intestine, and heart were performed. The results indicated that lower than 600 mg/kg of EEP and N-EEP can safely be used for the remediation of a spectrum of diseases.

ASSESSMENT OF SUBCHRONIC ORAL TOXICITY AND SAFETY PROFILE OF SUVARNAPARPATI IN WISTAR RATS

Suvarnaparpati is an ayurvedic metallic formulation used in gastrointestinal and respiratory disorders and as an antipyretic. The inclusion of heavy metals like mercury, sulfur and calcinated gold in Suvarnaparpati raises concerns and may lead to safety issues. Consequently, this research explores the sub-chronic oral toxicity of Suvarnaparpati in Wistar rats, adhering to OECD guideline 408, to analyse its safety profile. 24 Wistar rats were segmented into four groups. Animals received suvarnaparpati treatment continuously for 90 days at specified doses of 20.59 mg kg-1 (therapeutic dose-TD), 83.12 mg kg-1. (TD × 4) and 205.3 mg kg-1 (TD × 10). The effect of this formulation was examined on the water intake, food intake, urine analysis, hematology, serum biochemistry, organ-to-body weight ratio and histopathology of various organs, after 90 days of oral administration. Suvarnaparpati does not exhibit dose-related toxicity in Wistar rats of either sex across the said doses and may therefore be considered safe for human consumption.

Association between serum vitamin D status and severity of liver cirrhosis: implications for therapeutic targeting in Nigerian patients

BACKGROUND

Liver cirrhosis is a chronic and progressive liver disease with significant global health implications. Recent evidence suggests an association between serum vitamin D levels and the severity of liver cirrhosis, potentially serving as a therapeutic target. This study aimed to investigate the relationship between serum vitamin D status and the severity of liver cirrhosis in a population of Nigerian patients.

METHODS

This analytical, cross-sectional study involved 201 participants, including 103 with liver cirrhosis and 98 age- and sex-matched controls. Serum vitamin D was measured using ELISA, with deficiency defined as < 20 ng/ml. Cirrhosis severity was assessed using Child-Pugh and MELD scores. Spearman's correlation was used to assess the relationship between vitamin D and severity of liver cirrhosis while ordinal regression analysis assessed its performance as an indicator of the disease severity.

RESULT

Among cirrhotic patients, 36.9% were deficient, 31.1% insufficient, and 32.0% had sufficient vitamin D levels. Serum vitamin D showed strong negative correlations with Child-Pugh and MELD scores (r = -0.696, p < 0.001; r = -0.734, p < 0.001, respectively). Ordinal regression showed that higher vitamin D levels were associated with lower severity scores (Child-Pugh: OR = 0.856, 95% CI: 0.815-0.900, p < 0.001; MELD: OR = 0.875, 95% CI: 0.837-0.915, p < 0.001).

CONCLUSION

Lower serum vitamin D levels correlated with increased liver cirrhosis severity, suggesting its potential as both a prognostic marker and therapeutic target. Further studies should investigate the efficacy of vitamin D supplementation in improving cirrhosis outcomes.

[Application of Modified Polyether Sulfone Microspheres in Hyperbilirubinemia]

Objective

To design and prepare a high efficiency bilirubin adsorbent with good mechanical properties and biocompatibility.

Methods

In this study, quaternary ammonium pyridine was designed and synthesized, and then modified polyether sulfone microspheres, or PES/p(4-VP-co-N-VP)@6 microspheres, were prepared by phase conversion and electrostatic spraying. The morphology of the polymer components and the microspheres were studied by means of nuclear magnetic resonance (NMR) spectroscopy and scanning electron microscopy. The basic properties of the microspheres and their bilirubin adsorption efficiency were tested, and the adsorption mechanism was further explored. Blood cell counts and the clotting time of the microspheres were also measured.

Results

The diameter of the modified polyether sulfone microspheres prepared in the study was approximately 700-800 μm. Compared with the original PES microspheres, the surface and internal structure of PES/p(4-VP-co-N-VP)@6 microspheres did not change significantly, and they also had a loose porous structure, with some micropores scattered around in addition to irregular large pores. Compared with the control group, the bilirubin removal effect of the modified microspheres was (94.91±0.73)% after static adsorption in bilirubin PBS buffer solution for 180 min, with the difference being statistically significant (P<0.0001). According to the findings for the clotting time, the activated partial thromboplastin time (APTT) of the blank plasma group, the control PES group, and the modified PES microsphere group were (27.57±1.25) s, (28.47±0.45) s, and (30.4±0.872) s, respectively, and the difference between the experimental group and the other two groups was statistically significant (P<0.01, P<0.05). There was no significant change in red blood cell and white blood cell counts.

Conclusion

The microspheres prepared in the study have high efficiency in bilirubin adsorption, excellent mechanical properties and thermal stability, and good blood biocompatibility, and are expected to be used in the clinical treatment of patients with liver failure.

Bilirubin influences the predictive effect of body mass index on hospital mortality in critically ill patients

Introduction

Body mass index (BMI) can predict mortality in critically ill patients. Moreover, mortality is related to increased bilirubin levels. Thus, herein, we aimed to investigate the effect of bilirubin levels on the usefulness of BMI in predicting mortality in critically ill patients.

Methods

Data were extracted from the Medical Information Mart for Intensive Care (MIMIC IV) database. Patients were divided into two groups according to their total bilirubin levels within 24 h. Cox proportional hazard regression models were applied to obtain adjusted hazard ratios and 95 % confidence intervals for the correlation between BMI categories and hospital mortality. The dose-response relationship was flexibly modeled using a restricted cubic spline (RCS) with three knots.

Results

Of the 14376 patients included, 3.4 % were underweight, 29.3 % were of normal body weight, 32.2 % were overweight, and 35.1 % were obese. For patients with total bilirubin levels <2 mg/dL, hospital mortality was significantly lower in patients with obesity than in normal body weight patients (p < 0.05). However, the opposite results were observed for patients with total bilirubin levels ≥2 mg/dL. The Cox proportional hazard regression models suggested that the risk of death was lower in patients with overweightness and obesity than in normal body weight patients when the total bilirubin levels were <2 mg/dL, but not in the other case (total bilirubin levels ≥2 mg/dL). RCS analyses showed that, for patients with total bilirubin levels <2 mg/dL, the risk of death gradually decreased with increasing BMI. Conversely, for patients with total bilirubin levels ≥2 mg/dL, this risk did not decrease with increasing BMI until reaching obesity, after which it increased rapidly.

Conclusion

BMI predicted the risk of death differently in critically ill patients with different bilirubin levels.

Non-Invasive Hemodynamic Monitoring System Integrating Spectrometry, Photoplethysmography, and Arterial Pressure Measurement Capabilities

Minimally invasive and non-invasive hemodynamic monitoring technologies have recently gained more attention, driven by technological advances and the inherent risk of complications in invasive techniques. In this article, an experimental non-invasive system is presented that effectively combines the capabilities of spectrometry, photoplethysmography (PPG), and arterial pressure measurement. Both time- and wavelength-resolved optical signals from the fingertip are measured under external pressure, which gradually increased above the level of systolic blood pressure. The optical channels measured at 434-731 nm divided into three groups separated by a group of channels with wavelengths approximately between 590 and 630 nm. This group of channels, labeled transition band, is characterized by abrupt changes resulting from a decrease in the absorption coefficient of whole blood. External pressure levels of maximum pulsation showed that shorter wavelengths (<590 nm) probe superficial low-pressure blood vessels, whereas longer wavelengths (>630 nm) probe high-pressure arteries. The results on perfusion indices and DC component level changes showed clear differences between the optical channels, further highlighting the importance of wavelength selection in optical hemodynamic monitoring systems. Altogether, the results demonstrated that the integrated system presented has the potential to extract new hemodynamic information simultaneously from macrocirculation to microcirculation.

The correlation of ADMA with proinflammatory, liver injury and cancer biomarkers in patients with liver dysfunction

Background and Aim

Asymmetric dimethylarginine (ADMA) is an enzyme involved in vascular tone, blood pressure, and platelet activation. Serum ADMA levels are increased in liver diseases such as liver cirrhosis, hepatitis, and acute liver failure. The aim of our study was to assess the correlation of ADMA with proinflammatory, liver injury, and cancer biomarkers in patients with liver dysfunction of various etiologies.

Materials and Methods

We analyzed the demographic and clinical data, including serum ADMA concentration and other biochemical markers such as albumin, platelet count, international normalized ratio, bilirubin, and others in patients with hepatitis, compensated and decompensated liver cirrhosis, and hepatocellular carcinoma. The one-way ANOVA, Student's t-test, Mann-Whitney U test, univariate, and multivariate correlations were performed, and a p-value <0.05 was set as significant.

Results

In n=83 analyzed patients, we observed a negative correlation of ADMA with albumin concentration (p=0.049). We found a negative correlation between ADMA and platelet count in n=31 patients with compensated liver cirrhosis (p=0.022). We observed no significant correlations of ADMA with proinflammatory and cancer biomarkers in patients with hepatitis, compensated and decompensated liver cirrhosis, and hepatocellular carcinoma.

Conclusion

ADMA can potentially be used as a subsidiary marker of disease progression in patients with liver dysfunction. Our research suggests that ADMA cannot be useful in detecting hepatocellular carcinoma (HCC).

Safety of Macitentan for the Treatment of Portopulmonary Hypertension: Real-World Evidence from the Combined OPUS/OrPHeUS Studies

INTRODUCTION

Portopulmonary hypertension (PoPH) carries a worse prognosis than other forms of pulmonary arterial hypertension (PAH). Data regarding use of PAH-specific therapies in patients with PoPH are sparse as they are usually excluded from clinical trials. This analysis describes patient characteristics, treatment patterns, outcomes, and safety profiles in patients with PoPH newly initiating macitentan in the USA using the OPUS/OrPHeUS combined dataset.

METHODS

OPUS was a prospective, US, multicenter, observational drug registry (April 2014-June 2020); OrPHeUS was a retrospective, US, multicenter chart review (October 2013-March 2017). Additional information regarding patients' liver disease was retrospectively collected for patients with PoPH in OPUS.

RESULTS

The OPUS/OrPHeUS dataset included 206 patients with PoPH (median age 58 years; 52.4% female), with baseline cirrhosis and liver test abnormalities reported in 72.8% and 31.6% of patients respectively. Macitentan was initiated as combination therapy in 74.8% of patients and median (Q1, Q3) exposure to macitentan was 11.9 (3.1, 26.0) months. One-year Kaplan-Meier estimates (95% confidence limit, CL) of patients free from all-cause hospitalization and survival were 48.6% (40.7, 56.0) and 82.2% (75.1, 87.4). Of the 96 patients with PoPH in OPUS, 29.2% were classified as in need of liver transplant due to underlying liver disease during the study; transplant waitlist registration was precluded because of PAH severity for 32.1% and 17.9% were transplanted. Hepatic adverse events (HAE) were experienced by 49.0% of patients; the most common being increased bilirubin (16.0%), ascites (7.3%), and hepatic encephalopathy (5.8%); 1.5% and 21.8% of patients discontinued macitentan as a result of HAE and non-hepatic adverse events.

CONCLUSION

There were no unexpected safety findings in patients with PoPH treated with macitentan. These data add to the evidence supporting the safety and tolerability of macitentan in patients with PoPH. A graphical abstract is available with this article.

TRIAL REGISTRATION

OPsumit® Users Registry (OPUS): NCT02126943; OPsumit® Historical Users cohort (OrPHeUS): NCT03197688; www.

CLINICALTRIALS

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Classification Algorithms for Liver Epidemic Identification

Situated in the upper right region of the abdomen, beneath the diaphragm and above the stomach, lies the liver. It is a crucial organ essential for the proper functioning of the body.  The principal tasks are to eliminate generated waste produced by our organs, and digestive food and preserve vitamins and energy materials. It performs many important functions in the body, it regulates the balance of hormones in the body filtering and removing bacteria, viruses, and other harmful substances from the blood. In certain dire circumstances, the outcome can unfortunately result in fatality. There exist numerous classifications of liver diseases, based on their causes or distinguishing characteristics. Some common categories of liver disease include Viral hepatitis, Autoimmune liver disease, Metabolic liver disease, Alcohol-related liver disease, Non-alcoholic fatty liver disease, Genetic liver disease, Drug-induced liver injury, Biliary tract disorders. Machine learning algorithms can help identify patterns and risk factors that may be difficult for humans to detect. With this clinicians can enable early diagnosis of diseases, leading to better treatment outcomes and improved patient care. In this research work, different types of machine learning methods are implemented and compared in terms of performance metrics to identify whether a person effected or not. The algorithms used here for predicting liver patients are Random Forest classifier, K-nearest neighbor, XGBoost, Decision tree, Logistic Regression, support vector machine, Extra Trees Classifier. The experimental results showed that the accuracy of various machine learning models-Random Forest classifier-67.4%, K-nearest neighbor-54.8%, XGBoost-72%, Decision tree-65.1%, Logistic Regression-68.0%, support vector machine-65.1%, Extra Trees Classifier-70.2% after applying Synthetic Minority Over-sampling technique.

Salvia officinalis flowers extract ameliorates liver and kidney injuries induced by simultaneous intoxication with ethanol/castor oil

The current study investigated the possible mechanisms of aqueous extract Salvia officinalis flowers (SF-AE) and its protective effects against hepatorenal toxicities produced by simultaneous acute administration of ethanol (EtOH)/castor oil (CO). Healthy male rats (N = 50) were separated into five equal groups: control, Ethanol (EtOH) + Castor oil (CO), doses of increasing orders of SF-AE (50, 100, and 200 mg/kg, b.w., p.o.) during 15 days. Liver and kidney injuries were induced by EtOH (4 g/kg, b.w., p.o.) combined with CO (5 mL/kg, b.w., p.o.). Compared to the control group, SF-AE pretreatment protected against simultaneous administration of EtOH and CO-caused serious histological alterations in liver and kidney tissues. SF-AE also reversed liver and kidney biochemical parameters and lipid profile alterations. More importantly, SF-AE significantly reduced the malondialdehyde (MDA) level and counteracted the depletion of both enzymatic and non-enzymatic antioxidants. SF-AE also prevents against inflammation induced by EtOH combined with CO, expressed by the rise of inflammation biomarkers (C-reactive protein: CRP and alkaline phosphatase: ALP). Additionally, combined EtOH intoxication and CO poisoning exerted an increase in H2 O2 , free iron and calcium levels. Impressively, SF-AE treatment regulated levels of these studied intracellular mediators in a dose-dependent manner. In conclusion, SF-AE can potentially improve liver and kidney injuries associated with biochemical parameter deregulations, possibly by controlling oxidative stress and inflammation.

Cell and cell-derivative-based therapy for liver diseases: current approaches and future promises

INTRODUCTION

According to the recent updates from World Health Organization, liver diseases are the 12th most common cause of mortality. Currently, orthotopic liver transplantation (OLT) is the most effective and the only treatment for end-stage liver diseases. Owing to several shortcomings like finite numbers of healthy organ donors, lifelong immunosuppression, and complexity of the procedure, cell and cell-derivatives therapies have emerged as a potential therapeutic alternative for liver diseases. Various cell types and therapies have been proposed and their therapeutic effects evaluated in preclinical or clinical studies, including hepatocytes, hepatocyte-like cells (HLCs) derived from stem cells, human liver stem cells (HLSCs), combination therapies with various types of cells, organoids, and implantable cell-biomaterial constructs with synthetic and natural polymers or even decellularized extracellular matrix (ECM).

AREAS COVERED

In this review, we highlighted the current status of cell and cell-derivative-based therapies for liver diseases. Furthermore, we discussed future prospects of using HLCs, liver organoids, and their combination therapies.

EXPERT OPINION

Promising application of stem cell-based techniques including iPSC technology has been integrated into novel techniques such as gene editing, directed differentiation, and organoid technology. iPSCs offer promising prospects to represent novel therapeutic strategies and modeling liver diseases.

Antiplasmodial evaluation of aqueous extract of Blighia sapida K.D. Koenig leaves in Plasmodium berghei (NK65)-infected mice

Background

The study was designed to screen aqueous extract of Bilghia sapida leaves for its phytochemical constituents, in vivo antiplasmodial activity and biochemical changes in Plasmodium berghei (NK65)-infected female mice. Phytochemical screening was done using standard methods. In the acute toxicity test, three groups of mice received 1000, 2000 and 3000 mg/Kg/day of the extract respectively, and were observed for signs of toxicity, especially mortality for 24 h. Forty-eight mice were assigned into six groups of eight animals each. The uninfected group A (control) was administered distilled water, while groups B, C, D, E and F were inoculated intraperitoneally with about 107 parasitized erythrocytes and received distilled water, chloroquine (5 mg/Kg/day), 125, 250 and 500 mg/Kg/day of extract, respectively. The antiplasmodial activity was evaluated using Peter’s 4 days suppressive test. Haematological indices, selected biochemical parameters and liver histology were evaluated.

Results

Screening revealed the presence of six phytochemicals in the aqueous extract of B. sapida leaves. Median lethal dose of the extract is > 5,000 mg/Kg/day. The aqueous extract of the leaves significantly (P < 0.05) reduced the level of parasitaemia dose-dependently with chemosuppression of 74.09% at 500 mg/Kg/day. The extract significantly (P < 0.05) prevented P. berghei infection-associated reduction in red blood cell indices. The significant (P < 0.05) P. berghei-induced alterations in liver function indices were improved in extract-treated mice. There were no visible lesions in the livers of animals that received 125 mg/Kg/day of extract.

Conclusion

The aqueous extract of B. sapida leaves has in vivo antiplasmodial activity and justifies its folkloric use in malarial treatment.

Bacillus amyloliquefaciens CU33 fermented feather meal-soybean meal product improves the intestinal morphology to promote the growth performance of broilers

This study is aimed to select optimum keratin degradation ability from Bacillus strains for feather meal-soybean meal fermentation, and favorably water content for the strain during fermentation of feather meal-soybean meal, and finally investigate the effects of the fermented feather meal-soybean meal product (FFSMP) on growth performance, carcass trait, clinical blood biochemistry, and intestinal morphology of broilers. Thirty-six bacteria strains from soil, sewage pool, and feather waste were screened and selected Bacillus subtilis var. natto N21 (N21), B. subtilis CU14 (CU14), and B. amyloliquefaciens CU33 (CU33) with better keratinase activity and feather-degrading rate. The result of trial 1 showed that the FFSMP produced by CU33 had the optimum physiochemical characterizations, amino acid composition and feeding performance for broilers. Hence the effects of water content (45, 50, 55, and 60%) on FFMSP fermentation of CU33 were investigated in trial 2. Result showed that pH value, counts of Bacillus-like bacteria, γ-PGA, viscosity, surfactin yield and odor all significantly increased according to the water content (P < 0.05). The protease activity reached significantly highest in the 55% and 60% water content groups (P < 0.01). The broilers performance of 55% and 60% water content group were significantly higher than control group (P < 0.05) in weight gain (WG), feed intake (b) at 0 to 21-d-old and the WG, feed conversion ratio (FCR), and production efficiency factor at 0 to 35-d-old, and could reach the similar growth performance as fish meal group (P > 0.05). The fermentation groups significantly decreased urea nitrogen (P < 0.05) and increased creatinine (P < 0.05) in the blood. The fermentation groups also significantly decreased the crypt depth in the duodenum (P < 0.05) and increased villus height to crypt depth ratio of the duodenum (P < 0.05). In conclusion, CU33 shows the best degradation rate for feather and keratinase activity, and the FFSMP with a water content of 50% to 60% during fermentation is suggested. Diets supplemented with 5% FFSMP can promote the growth of broilers by improving the morphology of the duodenum and achieve the feeding effect of high-quality fish meal.

Optimized Tree Strategy with Principal Component Analysis Using Feature Selection-Based Classification for Newborn Infant's Jaundice Symptoms

One of the most important and difficult research fields is newborn jaundice grading. The mitotic count is an important component in determining the severity of newborn jaundice. The use of principal component analysis (PCA) feature selection and an optimal tree strategy classifier to produce automatic mitotic detection in histopathology images and grading is given. This study makes use of real-time and benchmark datasets, as well as specific approaches for detecting jaundice in newborn newborns. According to research, the quality of the feature may have a negative impact on categorization performance. Additionally, compressing the classification method for exclusive main properties can result in a classification performance bottleneck. As a result, identifying appropriate characteristics for training the classifier is required. By combining a feature selection method with a classification model, this is possible. The major outcomes of this study revealed that image processing techniques are critical for predicting neonatal hyperbilirubinemia. Image processing is a method of translating analogue images to digital formats and manipulating them. The primary goal of medical image processing is to collect information useful for disease detection, diagnosis, monitoring, and therapy. Image datasets can be used to validate the performance of newborn jaundice detection. When compared to conventional approaches, it offers results that are accurate, quick, and time efficient. Accuracy, sensitivity, and specificity, which are common performance indicators, were also predictive.