[Serum bilirubin subfractionation by high-performance liquid chromatography in patients with fulminant hepatic...

Serum bilirubin subfractionation, using high-performance liquid chromatography (HPLC), was carried out and clinically evaluated in 9 patients with fulminant hepatic failure (FHF). Serum unconjugated bilirubin (UCB), C-8 bilirubin mono-conjugate (MBC), C-12BMC and bilirubin di-conjugate (BDC) were quantified by the alkaline methanolysis-HPLC method described by Blanckaert. Similar studies were performed in 10 patients with acute hepatitis (AH) and 6 patients with obstructive jaundice and the results were compared. In patients with rising serum bilirubin, the serum C-12BMC/C-8BMC ratio was calculated to be as follows: 2.10 +/- 0.21 for FHF, 1.05 +/- 0.34 for AH and 0.81 +/- 0.08 for obstructive jaundice, respectively. A significant differences were observed between FHF and AH (P less than 0.01). As there was almost no overlapping, it was considered that this determination is useful for the differential diagnosis of jaundiced patients, especially, in those patients with AH whose sera show a prolonged prothrombin time lower than 40%, and there is a concern that they may develop FHF. The calculation of C-12BMC/C-8BMC allows us to make a differential diagnosis between AH and FHF at an early period in the development of the disease, and it was proved that serum C-12BMC/C-8BMC ratio can reflect the magnitude of hepatocyte damage as well as bilirubin metabolism disturbance.