ABSTRACT
We aimed to determine the predictors of coronary artery disease (CAD) in patients with abnormal bilirubin excretion, that is, Gilbert syndrome, Crigler-Najjar syndrome, Dubin-Johnson syndrome, and Rotor syndrome. We analyzed data from the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality, Rockville, MD for the period 2009 to 2010. All patients ≥18 years of age with a primary diagnosis of "disorders of bilirubin excretion" [International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9CM) code 277.4] were included in the study. Primary outcome was to determine predictors of CAD in adult patients diagnosed with abnormal bilirubin excretion. We identified a total of 12,423 adult patients with bilirubin excretion disorder hospitalized during 2009-2010 (0.03% of all inpatient admissions). CAD was seen in 18% of patients, with a higher prevalence in men (21% in men vs. 13% in women, P < 0.0001). In multivariate logistic regression adjusted for demographic and traditional risk factors, hypertension [odds ratio (OR): 1.74; 95% confidence interval (CI), 1.33-2.27, P < 0.001], hyperlipidemia (OR: 2.49; 95% CI, 1.95-3.18, P < 0.001), diabetes (OR: 1.46; 95% CI, 1.12-1.91, P = 0.01), and age (OR: 1.05; 95% CI, 1.04-1.06, P < 0.001) were found to be independent predictors of CAD in adult patients with abnormal bilirubin excretion. Female sex (OR: 0.49; 95% CI, 0.36-0.65, P < 0.001) demonstrated an inverse association in predicting CAD. There was increased prevalence of CAD in our patient population with increased prevalence of cardiovascular risk factors. Age, diabetes mellitus, hypertension, and hyperlipidemia were found to be independent predictors of CAD.
Subject(s)
Bilirubin/metabolism , Coronary Artery Disease/epidemiology , Hyperbilirubinemia, Hereditary/epidemiology , Bilirubin/blood , Coronary Artery Disease/blood , Diabetes Mellitus/epidemiology , Female , Humans , Hyperbilirubinemia, Hereditary/blood , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Sex FactorsABSTRACT
Inherited disorders of bilirubin metabolism involve four autosomal recessive syndromes: Gilbert, CriglerNajjar, Dubin-Johnson and Rotor, among which the first two are characterized by unconjugated and the second two by conjugated hyperbilirubinemia. Gilbert syndrome occurs in 2%-10% of general population, while others are rare. Except for Crigler-Najjar syndrome, hereditary hyperbilirubinemias belong to benign disorders and thus no treatment is required.
Subject(s)
Hyperbilirubinemia, Hereditary , Bilirubin/genetics , Bilirubin/metabolism , Crigler-Najjar Syndrome/epidemiology , Crigler-Najjar Syndrome/genetics , Crigler-Najjar Syndrome/therapy , Gilbert Disease/epidemiology , Gilbert Disease/genetics , Gilbert Disease/therapy , Humans , Hyperbilirubinemia/epidemiology , Hyperbilirubinemia/genetics , Hyperbilirubinemia/therapy , Hyperbilirubinemia, Hereditary/classification , Hyperbilirubinemia, Hereditary/epidemiology , Hyperbilirubinemia, Hereditary/genetics , Hyperbilirubinemia, Hereditary/therapySubject(s)
Hyperbilirubinemia, Hereditary/epidemiology , Mitochondrial Proteins , Saccharomyces cerevisiae Proteins , Age Factors , Databases, Factual , Diagnosis, Differential , Female , Glucuronosyltransferase/genetics , Humans , Hyperbilirubinemia, Hereditary/diagnosis , Hyperbilirubinemia, Hereditary/etiology , Internet , Japan/epidemiology , Male , Mutation , Prognosis , Reference Standards , Ribosomal Proteins/genetics , Sex FactorsABSTRACT
Liver function tests and prevalence of different symptoms generally said to occur in Gilbert's syndrome were analysed in male conscripts and in male and female participants in two cross-sectional population studies in Göteborg, in total 2395 subjects. The serum bilirubin levels showed a skew distribution without bimodality. We observed no tendency to higher prevalence of symptoms in subjects with high serum bilirubin levels, but normal alkaline phosphatase and aminotransferase values compared to subjects with normal bilirubin. The findings contradict the existence of a disease entity named "Gilbert's syndrome".
Subject(s)
Gilbert Disease/epidemiology , Hyperbilirubinemia, Hereditary/epidemiology , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Gilbert Disease/blood , Humans , Liver Function Tests , Male , Middle Aged , SwedenABSTRACT
The prevalence of Gilbert's syndrome was studied in a randomized group of 1530 persons (785 men and 745 women, aged 20-40 years) living in the Heidelberg region of the Federal Republic of Germany. It was found to be present in 12.4% of men and 4.8% of women, i.e. a total of 8.6% for the entire group. In women the serum bilirubin level (mean 12.0 +/- 5.1 mumol/l) was significantly lower than in men (mean of 13.7 +/- 6.8 mumol/l; P less than 0.001). Analysing the frequency distribution of serum bilirubin revealed that patients with this syndrome do not constitute a population of its own, but rather form the upper end of the normative bilirubin distribution curve.
Subject(s)
Gilbert Disease/epidemiology , Hyperbilirubinemia, Hereditary/epidemiology , Adult , Female , Germany, West , Humans , MaleSubject(s)
Hyperbilirubinemia, Hereditary/epidemiology , Jaundice, Chronic Idiopathic/epidemiology , Adolescent , Adult , Child , Female , Humans , Japan , Male , Surveys and QuestionnairesABSTRACT
Total serum bilirubin concentration was measured by an Autoanalyzer technique in 197 normal males and 102 normal females. The mean bilirubin concentration was significantly lower in the females than in the males. Total bilirubin concentration in the males showed a bimodal distribution with an antimode at 24 mumol/1 (1.4 mg/100ml). Individuals with bilirubin concentration above this value had unconjugated hyperbilirubinaemia and probable Gilbert's syndrome. Total bilirubin concentration in the females again showed a bimodal distribution with an antimode at 12 mumol/1 (0.7 mg/100ml). It is conceivable that females with bilirubin levels above this also have Gilbert's syndrome. This suggests that the population incidence of Gilbert's syndrome could be as high as 6% and that the sex incidence is approximately equal.
