Relationship between elevated bilirubin level and subclinical atherosclerosis as well as oxidative stress in Gilbert syndrome

Busra Copur; Nisbet Yilmaz; Canan Topcuoglu; Emrullah Kiziltunc; Mustafa Cetin; Turan Turhan; Burak Furkan Demir; Emin Altiparmak; Ihsan Ates

Relationship between elevated bilirubin level and subclinical atherosclerosis as well as oxidative stress in Gilbert syndrome

Gastroenterol Hepatol Bed Bench. 2020 Spring;13(2):133-140.

Authors

Busra Copur¹, Nisbet Yilmaz¹, Canan Topcuoglu², Emrullah Kiziltunc³, Mustafa Cetin³, Turan Turhan², Burak Furkan Demir¹, Emin Altiparmak⁴, Ihsan Ates¹

Affiliations

¹ Ankara Numune Training and Research Hospital, Internal Medicine Department, Ankara, Turkey.
² Ankara Numune Training and Research Hospital, Department of Biochemistry, Ankara, Turkey.
³ Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
⁴ Ankara Numune Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey.

PMID: 32308934
PMCID: PMC7149819

Abstract

Aim: This study aimed to determine oxidant status and left ventricular mass index (LVMI) and their relationship with mild hyperbilirubinemia in patients with Gilbert syndrome (GS).

Background: Gilbert syndrome (GS) presents with mild indirect hyperbilirubinemia, normal liver function tests, and normal hepatic histology.

Methods: A total of 84 patients, including 41 (48.8%) patients with GS and 43 (51.2%) patients without GS, were included in the study. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were examined for oxidant status.

Results: TAS was found to be higher in the GS patients compared to the non-GS patients (1.7±0.1 vs. 1.5±0.2; p=0.002); there was no significant difference between the groups in terms of mean TOS and mean OSI (p>0.05). No significant difference was observed either between the GS and non-GS patients in terms of mean left ventricular volume and mean LVMI (p>0.05). However, subgroup analysis based on sex revealed that GS patients had a lower LVMI for both sexes. In GS patients, TAS level had a positive correlation with albumin (r=0.319; p=0.042), triglyceride (r=0.392; p=0.011), total bilirubin (r=0.420; p=0.006), direct bilirubin (r=0.361; p=0.020), and indirect bilirubin (r=0.338; p=0.0311) levels; no correlation was found between TAS level and other laboratory findings (p>0.05). The regression model indicated that risk factors of direct bilirubin (β±SE=0.13±0.03; p<0.001), uric acid (β±SE=0.04±0.01; p=0.001), and albumin (β±SE=0.17±0.04; p<0.001) were independent predictors of TAS level.

Conclusion: This study revealed a relationship between mild hyperbilirubinemia and antioxidant balance in GS. Although statistical significance was not reached, LVMI was found to be lower in the GS group compared to the non-GS group for both sexes.

Keywords: Gilbert syndrome; Hyperbilirubinemia; Oxidative stress; Subclinical atherosclerosis.