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• W3093947425 abstract "INTRODUCTION: Research done in the 1950’s and 60’s described the occurrence of extravascular hemolysis in a subset of patients with alcoholic cirrhosis. Subsequent studies suggested that hemolysis in this setting is the result of acquired red blood cell abnormalities in the setting of hypersplenism. In the decades since, this phenomenon and its potential clinical significance have received little attention. The objective of this study was to examine levels of indirect hyperbilirubinemia in patients with different forms of advanced liver disease. METHODS: Clinical and laboratory data were compared among 3 groups of patients admitted to the University of Iowa Hospital between January 2010 and January 2018. Fifty subjects each with alcoholic hepatitis (AH), decompensated alcoholic cirrhosis (AC) and decompensated cirrhosis due to causes other than alcohol (N-AC) in whom fractionated bilirubin had been obtained at admission were selected for study. Statistical analysis was done using Excel. RESULTS: As would be expected, total bilirubin was significantly higher in AH versus AC and N-AC. Absolute levels of direct bilirubin were also highest in AH but the indirect bilirubin comprised only about a quarter of the total in this group. Conversely, the indirect bilirubin comprised nearly half of the total bilirubin in AC and about 60% in N-AC. Hemoglobin levels were similar among the groups, but RBC counts were slightly lower in AH versus N-AC. MCV, MCH, and MCHC were highest in AH, perhaps reflecting the effects of recent heavy alcohol ingestion. Spleen sizes were similar among the groups. CONCLUSION: Our data show that, in contrast to AH, hyperbilirubinemia in decompensated cirrhosis is characterized by a large indirect fraction. Indirect bilirubin in cirrhotic patients seems unlikely to be a direct consequence of the severity of the underlying liver disease, given that direct bilirubin predominates in severe AH, which indicates that the ability to conjugate bilirubin is preserved even in conditions of severe hepatocellular dysfunction. Extravascular hemolysis due to acquired red cell membrane abnormalities and/or hypersplenism may contribute to elevations in indirect bilirubin. Hemolysis markers (LDH, haptoglobin) were not routinely obtained in the patients in this study, limiting our ability to evaluate this possibility. Further study is needed to determine the cause and clinical significance of indirect hyperbilirubinemia in cirrhosis.Table 1.: Comparison of variables with features of advanced liver disease among three study groups; 1. alcoholic hepatitis (AH) 2. decompensated alcoholic cirrhosis (AC) and 3. decompensated non-alcoholic cirrhosis (N-AC)Table 2.: Comparison of clinical and laboratory data among the three study groups i.e. 1. alcoholic hepatitis (AH) 2. decompensated alcoholic cirrhosis (AC) and 3. decompensated non-alcoholic cirrhosis (N-AC)Figure 1.: Comparing the proportion of indirect bilirubin between three study groups." @default.
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• W3093947425 date "2020-10-01" @default.
• W3093947425 modified "2023-09-25" @default.
• W3093947425 title "S1019 Indirect Bilirubin Predominates in Hyperbilirubinemia Due to Cirrhosis: Comparison With Alcoholic Hepatitis" @default.
• W3093947425 doi "https://doi.org/10.14309/01.ajg.0000706124.82421.4d" @default.
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