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Unconjugated hyperbilirubinemia may exacerbate certain underlying chronic liver diseases

Roman Dascal1, Julia Uhanova1, Gerald Y Minuk1,2

  • 1Section of Hepatology, Department of Medicine, Winnipeg, Manitoba, Canada.

Canadian Liver Journal
|December 25, 2023
PubMed

Insights

Unconjugated hyperbilirubinemia (UCB) in chronic liver disease (CLD) patients is linked to increased liver inflammation and fibrosis, contrary to previous findings in other inflammatory conditions. This study highlights a potential association between UCB and disease severity in specific CLDs.

Area of Science:

  • Hepatology
  • Biochemistry
  • Immunology

Background:

  • Previous research indicated a negative correlation between elevated unconjugated bilirubin and chronic inflammatory diseases.
  • The association between unconjugated hyperbilirubinemia (UCB) and chronic liver diseases (CLD) has not been previously investigated.

Purpose of the Study:

  • To evaluate hepatic necro-inflammatory disease activity and fibrosis in CLD patients with and without UCB.
  • To determine if UCB is associated with increased or decreased liver disease markers in CLD.

Main Methods:

  • Serum aminotransferase levels were used to assess necro-inflammatory activity.
  • APRI and FIB-4 scores were calculated to evaluate fibrosis.
  • UCB patients were matched 1:2 with controls based on age, gender, and CLD type.

Main Results:

  • 208 (2.1%) of 9,745 CLD patients had UCB, with 399 controls.
  • UCB patients exhibited significantly higher aminotransferase levels, APRI, and FIB-4 scores.
  • This association was prominent in chronic viral and immune-mediated liver disorders, not NAFLD, ALD, or 'other' CLDs.

Conclusions:

  • UCB is associated with heightened hepatic necro-inflammatory activity and fibrosis in specific CLDs.
  • The findings challenge the previously observed inverse relationship between UCB and inflammation in other conditions.
  • Further research is warranted to elucidate the mechanisms underlying UCB's role in CLD progression.

Keywords:
Gilbert’s diseasebilirubinchronic liver diseaseconjugatedhepatitisliver diseaseunconjugated

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