Is bilirubin/albumin ratio correlated with unbound bilirubin concentration?

Sato, Yuichi; Morioka, Ichiro; Miwa, Akihiro; Yokota, Tomoyuki; Matsuo, Koichiro; Koda, Tsubasa; Fujioka, Kazumichi; Morikawa, Satoru; Shibata, Akio; Yokoyama, Naoki; Takahashi, Kaoru; Nishio, Hisahide; Matsuo, Masafumi

doi:10.1111/j.1442-200x.2011.03457.x

Cited by 23 publications

(17 citation statements)

References 14 publications

(25 reference statements)

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“…Thus, low albumin levels in the preterm infant may also be involved in the cytotoxicity of bilirubin and may hold prognostic value. Because unbound bilirubin is difficult to measure compared to total bilirubin, the ratio of total bilirubin/albumin may allow for estimation of exposure of the neonatal brain to unbound bilirubin (Sato et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants

Rose

Vassar

Cahill‐Rowley

et al. 2014

NeuroImage: Clinical

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Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age.Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin.Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = −.322, p = .009; r= −.381, p= .002), lower mean albumin (r = −.276, p= .029; r= −.385, p= .002), and lower mean bilirubin (r = −.293, p= .020; r= −.337 p= .007).Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopm...

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Section: Discussionmentioning

confidence: 99%

Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants

Rose

Vassar

Cahill‐Rowley

et al. 2014

NeuroImage: Clinical

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“…Serum TB and UB levels were measured at the same time using a Food and Drug Administration-approved analyzer (UB Analyzer; Arrows Co., Ltd, Osaka, Japan) by spectrophotometry and the glucose oxidase-peroxidase method, respectively, as previously described [8,[13][14][15][16]. Serum UB levels were measured using the single peroxidase concentration method, as recommended by the manufacturer, because this has a higher precision than the two peroxidase concentration method [13].…”

Section: Assay Methodsmentioning

confidence: 99%

Serum unbound bilirubin as a predictor for clinical kernicterus in extremely low birth weight infants at a late age in the neonatal intensive care unit

Morioka

Nakamura

Koda

et al. 2015

Brain and Development

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“…It has been suggested that the sensitivity and specificity of B/A to acute injury caused by bilirubin reach 100% when the broad value of B/A is higher than TSB [19]. However, another study showed that although TSB and B/A were both effective indicators for predicting bilirubin-induced neurological injury, the use of B/A alone was not superior to the use of TSB alone [20]. In our study, B/A fluctuated widely in the presence of etiological risk factors.…”

Section: Discussionmentioning

confidence: 99%

Increased serum total bilirubin-albumin ratio was associated with bilirubin encephalopathy in neonates

et al. 2020

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We performed the present study to summarize the recent epidemiological characteristics of bilirubin encephalopathy and assess the role of total bilirubin-albumin ratio in the bilirubin encephalopathy. We retrospectively collected clinical data of 669 neonates with hyperbilirubinemia from the First Affiliated Hospital of Zhengzhou University between January 2015 and July 2018, including 153 neonates belonged to bilirubin encephalopathy and 516 ones were treated as control group. Compared with the control group, those with bilirubin encephalopathy have higher bilirubin-albumin ratio (13.8 ± 3.6 vs. 10.6 ± 2.5, P=0.000). The direct bilirubin and indirect bilirubin level were higher in the case group than that in the control group (P=0.000). On the contrary, the hemoglobin level was lower in the case group than that in the control group (P=0.004). There were no significant differences in gestational age (P=0.510), gender rate (P=0.313), maternal gestational diabetes ratio (P=0.071), natural childbirth ratio (P=0.686), and meconium delay (P=0.091). The results from univariate regression indicated the total bilirubin/albumin ratio was positively associated with bilirubin encephalopathy (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.59–3.14). The total bilirubin, direct bilirubin, and indirect bilirubin were also related to encephalopathy. After adjusting some potential cofounding factors, the total bilirubin-albumin was still associated with bilirubin encephalopathy. The higher total bilirubin-albumin ratio increased the risk of bilirubin encephalopathy by 23% (OR = 1.23, 95% CI: 1.16–2.48). Our results indicated that the bilirubin-albumin ratio is associated with bilirubin encephalopathy in neonates, and could be a potential predictor.

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Is bilirubin/albumin ratio correlated with unbound bilirubin concentration?

Abstract: The B/A ratio is significantly correlated with serum UB concentration in newborns ≥ 35 weeks of gestation. The B/A ratio, however, is underestimated when serum UB concentrations are >0.6 µg/dL.

Cited by 23 publications

References 14 publications

Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants

Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants

Serum unbound bilirubin as a predictor for clinical kernicterus in extremely low birth weight infants at a late age in the neonatal intensive care unit

Increased serum total bilirubin-albumin ratio was associated with bilirubin encephalopathy in neonates

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