Unconjugated hyperbilirubinemia is inversely associated with non-alcoholic steatohepatitis (NASH)
Version of Record online: 29 APR 2012
Published 2012. This article is a US Government work and is in the public domain in the USA.
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 12, pages 1416–1423, June 2012
How to Cite
Hjelkrem, M., Morales, A., Williams, C. D. and Harrison, S. A. (2012), Unconjugated hyperbilirubinemia is inversely associated with non-alcoholic steatohepatitis (NASH). Alimentary Pharmacology & Therapeutics, 35: 1416–1423. doi: 10.1111/j.1365-2036.2012.05114.x
- Issue online: 14 MAY 2012
- Version of Record online: 29 APR 2012
- Manuscript Accepted: 9 APR 2012
- Manuscript Revised: 3 APR 2012
- Manuscript Revised: 23 MAR 2012
- Manuscript Received: 12 MAR 2012
It has been recognised that unconjugated bilirubin contains hepatic anti-fibrogenic and anti-inflammatory properties and is a potent physiological antioxidant cytoprotectant. We believe that unconjugated hyperbilirubinemia may protect against development of non-alcoholic steatohepatitis (NASH).
This study was conducted to assess the association of serum unconjugated bilirubin levels and histological liver damage in non-alcoholic fatty liver disease (NAFLD).
This was a retrospective analysis involving adult patients from a tertiary medical centre undergoing liver biopsy to evaluate suspected NAFLD or NASH and a control group without NAFLD based on normal liver ultrasound, labs and history. Identification of unconjugated hyperbilirubinemia was based on the presence of predominantly unconjugated bilirubin ≥1.0 mg/dL (17.1 μmol/L) while fasting, in the absence of haemolytic disease or other hepatic function alteration.
Six-hundred and forty-one patients were included. Unconjugated hyperbilirubinemia was inversely associated with NASH (OR 16.1, 95% CI 3.7–70.8 P < 0.001). Of the patients without NAFLD (133 patients), 13 (9.8%) had unconjugated hyperbilirubinemia (range 1.0–1.8, mean 1.4). Of the patients with NAFLD without NASH (285 patients), 32 (11.2%) had unconjugated hyperbilirubinemia (range 1.0–3.0, mean 1.4). Of the patients with NASH (223 patients), three (1.3%) had unconjugated hyperbilirubinemia (1.0, 1.1, 1.4).
Unconjugated hyperbilirubinemia is inversely associated with the histopathological severity of liver damage in non-alcoholic fatty liver disease.