Gut peptide changes in patients with obstructive jaundice undergoing biliary drainage: A prospective case control study

doi:10.12998/wjcc.v10.i17.5551

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World Journal of Clinical Cases

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Case Control Study

World J Clin Cases. Jun 16, 2022; 10(17): 5551-5565
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5551

Table 1 Clinical characteristics of the participants

		Benign etiology (n = 34)	Malignant etiology (n = 21)	Control (n = 40)	P value
Gender	Female	12 (35%)	9 (43%)	13 (32%)
Gender	Male	22 (65%)	12 (57%)	27 (68%)
Age (yr)	Median (Q1-Q3)	55.0 (43.0-67.0)	66.0 (60.5-83.0)	55.0 (43.0-67.0)
	Min-max	33-84	55-88	39-90
Biliary obstruction etiology	Biliary stones	28 (82%)
	Chronic pancreatitis	5 (15%)
	Stenosing papillitis	1 (3%)
	Tumor of pancreatic head		15 (72%)
	Malignant lymphadenopathy		4 (19%)
	Cholangiocarcinoma		2 (9%)
Duration of biliary obstruction (d)		10.0 (5.0-20.2)	14.0 (10.0-21.0)	NA	0.045¹
Body weight (kg)		80.5 (73.5-92.0)	61.0 (46.0-75.8)	72.5 (63.0-75.4)	0.04¹
BMI (kg/m²)		26.9 (23.7-28.7)	21.8 (17.0-24.0)	25.8 (22.9-27.9)	0.001¹
Weight loss (%)		3.8 (0.0-7.6)	12.0 (8.1-18.0)	0.0 (0.0-0.0)	0.002²
Body fat (%)		24.0 (22.0-25.3)	19.0 (13.0-24.0)	29.5 (27.0-32.0)	< 0.001²
NRS 2002		2.5 (0.0-3.3)	4.0 (3.5-5.0)	0.0 (0.0-0.0)	< 0.001²
NRS 2002	< 3	17 (50%)	2 (9.5%)	38 (95%)	< 0.001²
	≥ 3	17 (50%)	19 (90.5%)	2 (5%)
Appetite (VAS)		4.0 (2.8-6.3)	3.0 (2.0-6.0)	4.0 (2.0-5.0)	0.641²
Pain (VAS)		0.0 (0.0-1.3)	1.0 (0.0-2.5)	0.0 (0.0-0.0)	0.001²
Helicobacter pylori infection		12 (35.2%)	8 (38.1%)	3 (7.5%)	0.005²
Smoking		15 (44.1%)	0 (0%)	7 (17.5%)	< 0.001²

¹Mann-Whitney U test (comparison between benign and malignant groups).

²Kruskal-Wallis test (comparison between all three groups).

Values are presented as median (Q1-Q3) for continuous and as n (%) for categorical variables. BMI: Body mass index; NRS: Nutritional risk screening; VAS: Visual Analogue Scale; NA: Not available.

Table 2 Etiology of biliary obstruction and various humoral parameters, median (25%-75%)

Parameter	Benign etiology (n = 34)	Malignant etiology (n = 21)	P value¹	Controls (n = 40)	P value²
CRP (mg/L)	13.1 (6.6-19.6)	6.3 (2.9-11.3)	0.001	2.3 (0.9-3.4)	< 0.001
ES (mm/h)	25 (13.0-31.5)	25 (12.0-41.0)	NS	6.5 (4-13.2)	< 0.001
Leukocytes (× 10⁹)	6.7 (4.9-8.9)	6.7 (3.9-7.0)	NS	5.9 (5.5-7.2)	NS
Hemoglobin (g/L)	141 (123.8-147.0)	125 (113.5-134.5)	0.002	140 (135.0-156.5)	< 0.001
Thrombocytes (× 10⁹)	220 (197.2-248.3)	178 (113.5-289.5)	NS	241 (188.5-289)	0.042
Bilirubin (mmol/L)	85.3 (51.9-183.3)	270 (145-359.8)	< 0.001	12.1 (10.7-14.0)	< 0.001
AST (U/L)	123 (84.0-212.3)	155.0 (78.0-186.0)	NS	19.0 (18.0-23.8)	< 0.001
ALT (U/L)	337.5 (84.8-547.5)	232 (114-355.5)	NS	16.0 (14.0-21.8)	< 0.001
GGT (U/L)	448 (333.8-602.8)	396.0 (243.5-892.5)	NS	18.0 (16.0-25.8)	< 0.001
ALP (U/L)	287.5 (261.8-418.5)	281.0 (243.5-434.0)	NS	83.5 (63.5-94.3)	< 0.001
Blood glucose (mmol/L)	5.8 (5.2-6.7)	6.7 (6.3-7.6)	0.006	5.3 (4.8-5.6)	< 0.001
Creatinine (mmol/L)	89.0 (82.0-110.5)	105.0 (80.5-123.5)	NS	84.5 (76.0-104.0)	0.032
Calcium (mmol/L)	2.3 (2.2-2.5)	2.4 (2.3-2.4)	NS	2.4 (2.3-2.4)	NS
LDH (U/L)	187.5 (152.8-213.5)	196.0 (175.0-232.5)	NS	158.0 (147.3-188.0)	0.004
Cholesterol (U/L)	5.2 (4.9-6.8)	5.4 (4.7-8.4)	NS	6.0 (5.5-6.6)	0.033
Triglycerides (mmol/L)	1.9 (1.1-2.3)	2.4 (1.9-3.1)	0.005	1.3 (1.1-1.6)	< 0.001
Albumin (g/L)	37.8 (32.9-41.0)	36.0 (33.1-39.3)	NS	43.0 (42.0-44.1)	< 0.001
Ghrelin (pg/mL)	1449.5 (1124.5-2398.8)	1646.0 (1010.0-4179.0)	NS	533.5 (368.5-931.5)	< 0.001
CCK (pg/mL)	291.7 (160.9-411.7)	191.0 (142.6-218.5)	NS	153.1 (72.3-262.4)	< 0.001
IL-6 (pg/mL)	7.0 (5.0-18.3)	9.0 (80-11.0)	NS	2.5 (2.0-4.0)	< 0.001
TNF-α (pg/mL)	11.0 (8.0-12.0)	12.0 (10.5-14.5)	NS	6.0 (5.0-7.0)	< 0.001

¹Mann-Whitney U test (comparison between benign and malignant groups).

²Kruskal-Wallis test (comparison between all three groups).

Values are presented as median (Q1-Q3). AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; CRP: C-reactive protein; CCK: Cholecystokinin; ES: Erythrocyte sedimentation rate; GGT: Gamma-glutamyl transferase; LDH: Lactate dehydrogenase; NS: Not significant; IL-6: Interleukin 6; TNF-α: Tumor necrosis factor α.

Table 3 Correlation of inflammatory markers and appetite regulating hormones with various nutritional parameters

Spearman's correlation coefficient		CRP (mg/L)	IL-6 (pg/mL)	TNF-α (pg/mL)	Ghrelin (pg/mL)	CCK (pg/mL)
Weight loss (%)	rho	-0.21	0.263	0.438	0.12	0.242
Weight loss (%)	P	0.124	0.052	0.001	0.385	0.075
BMI (kg/m²)	rho	0.638	0.31	0.024	-0.342	0.411
BMI (kg/m²)	P	0.001	0.021	0.861	0.011	0.002
NRS2002	rho	-0.236	0.193	0.355	-0.057	0.142
NRS2002	P	0.083	0.157	0.008	0.682	0.302
Adipose tissue (%)	rho	0.313	0.136	0.069	-0.348	0.289
Adipose tissue (%)	P	0.02	0.324	0.617	0.009	0.033
Albumin (g/L)	rho	0.002	-0.384	-0.461	-0.024	-0.026
Albumin (g/L)	P	0.987	0.004	0.001	0.861	0.848
Cholesterol (U/L)	rho	-0.162	0.054	-0.212	0.209	0.355
Cholesterol (U/L)	P	0.238	0.696	0.121	0.125	0.008
Apetite (VAS)	rho	0.047	0.039	0.037	0.027	-0.121
Apetite (VAS)	P	0.733	0.776	0.786	0.847	0.379

CRP: C-reactive protein; IL-6: Interleukin 6; TNF-α: Tumor necrosis factor α; CCK: Cholecystokinin; BMI: Body mass index; NRS: Nutritional risk screening; VAS: Visual analog scale.

Table 4 Effects of biliary drainage

	During biliary obstruction (n = 55)	48 h after drainage (n = 55)	28 d after drainage (n = 55)	P value¹
Bilirubin (mmol/L)	145 (63.9-230.7)	88.5 (38.75-190.5)	25 (18.85-38.7)	< 0.001
ALT (U/L)	133 (78-194)	91.5 (63.75-144.25)	30 (23-46.5)	< 0.001
GGT (U/L)	278 (103-421)	194 (103.25-267.25)	36 (28-64)	< 0.001
ALP (U/L)	448 (288.5-612.5)	382.5 (184-606.5)	85 (61-111)	< 0.001
AST (U/L)	284 (260.5-382)	281.5 (231.75-429.25)	123 (103.5-166)	< 0.001
CRP (mg/L)	10.0 (5.8-14.1)	17.9 (5.9-26.8)	8.3 (2.5-17.3)	0.009
IL-6 (pg/mL)	9 (6-13)	11 (7-22)	9 (5-21.5)	0.332
TNF-α (pg/mL)	11 (8.5-13)	10 (9-12)	10 (8-12.5)	0.088
Ghrelin (pg/mL)	1549 (1079.5-2400.5)	1648.5 (1137.25-2767)	1612 (891.5-2962)	0.552
Cholecystokinin (pg/mL)	213.0 (161.0-380.7)	266.0 (203.0-400.5)	235.0 (158.0-433.0)	0.03
Albumin (g/L)	37.1 (33.0-40.8)	35.0 (32.4 -38.0)	38.0 (35.0-42.0)	< 0.001
Appetite (VAS)	4 (2-6)	6 (4-8)	7 (6-9)	< 0.001
BMI (kg/m²)	24.5 (21.3-28.2)	24.4 (20.6-27.9)	24.9 (21.2-26.8)	< 0.001
Body fat (%)	23 (17-25)	23 (17-24)	23 (19-25)	0.002
NRS 2002	3.0 (2.0-4.0)	3.5 (2.0-4.0)	0.0 (0.0-4.0)	< 0.001

¹Friedman test across three observations.

Values are presented as median (Q1-Q3); ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; AST: Aspartate aminotransferase; CRP: C-reactive protein; IL-6: Interleukin 6; TNF-α: Tumor necrosis factor α; VAS: Visual analog scale; BMI: Body mass index; NRS: Nutritional risk screening.

Citation: Pavić T, Pelajić S, Blažević N, Kralj D, Milošević M, Mikolasevic I, Lerotic I, Hrabar D. Gut peptide changes in patients with obstructive jaundice undergoing biliary drainage: A prospective case control study. World J Clin Cases 2022; 10(17): 5551-5565
URL: https://www.wjgnet.com/2307-8960/full/v10/i17/5551.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i17.5551