Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2024; 15(1): 34-42
Published online Jan 15, 2024. doi: 10.4239/wjd.v15.i1.34
Predictive value of bilirubin and serum γ-glutamyltranspeptidase levels in type-2 diabetes mellitus patients with acute coronary syndrome
Jie Chen, Wan-Chao Zhang, Xiao-Qiang Tang, Ruo-Han Yin, Tao Wang, Xiao-Yu Wei, Chang-Jie Pan
Jie Chen, Xiao-Qiang Tang, Ruo-Han Yin, Tao Wang, Xiao-Yu Wei, Chang-Jie Pan, Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
Wan-Chao Zhang, Radiology Department, The People’s Hospital of WuQia County, Wuqia 845450, Xinjiang Uygur Autonomous Region, China
Co-first authors: Jie Chen and Wan-Chao Zhang.
Author contributions: Chen J and Zhang WC conceived and designed the experiments; Chen J, Zhang WC, Tang XQ, Yin RH, Wang T and Pan CJ collected and analyzed the data; Wei XY and Pan CJ contributed to the data collection; Chen J and Zhang WC overall supervise the study. All authors have approved the manuscript. Chen J and Zhang WC contributed equally to this work and are co-first authors, including design of the study, acquiring and analyzing data from experiments, and writing of the actual manuscript.
Supported by Science and Technology Major Project of Changzhou Science and Technology Bureau, No. CE20205047; Natural Science Foundation of Xinjiang Uygur Autonomo us Region, No. 2022D01F52; Changzhou A major scientific research project of the Municipal Health Commission, No. ZD202220.
Institutional review board statement: The study was reviewed and approved by the The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University (Approval No. YLJSA302).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Chang-Jie Pan, MD, Doctor, Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, No. 68 Ge Hu Middle Road, Wu Jin District, Changzhou 213164, Jiangsu Province, China.
Received: August 9, 2023
Peer-review started: August 9, 2023
First decision: October 8, 2023
Revised: November 13, 2023
Accepted: December 8, 2023
Article in press: December 8, 2023
Published online: January 15, 2024

Cardiovascular disease is a major complication of diabetes mellitus (DM). Type-2 DM (T2DM) is associated with an increased risk of cardiovascular events and mortality, while serum biomarkers may facilitate the prediction of these outcomes. Early differential diagnosis of T2DM complicated with acute coronary syndrome (ACS) plays an important role in controlling disease progression and improving safety.


To investigate the correlation of serum bilirubin and γ-glutamyltranspeptidase (γ-GGT) with major adverse cardiovascular events (MACEs) in T2DM patients with ACS.


The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively. According to different conditions, they were divided into the T2DM complicated with ACS group (T2DM + ACS, n = 96), simple T2DM group (T2DM, n = 85), and simple ACS group (ACS, n = 90). The clinical data and laboratory indices were compared among the three groups, and the correlations of serum total bilirubin (TBIL) levels and serum γ-GGT levels with other indices were discussed. T2DM + ACS patients received a 90-day follow-up after discharge and were divided into event (n = 15) and nonevent (n = 81) groups according to the occurrence of MACEs; Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.


The T2DM + ACS group showed higher γ-GGT, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups (P < 0.05). Based on univariate analysis, the event and nonevent groups were significantly different in age (t = 3.3612, P = 0.0011), TBIL level (t = 3.0742, P = 0.0028), γ-GGT level (t = 2.6887, P = 0.0085), LDL-C level (t = 2.0816, P = 0.0401), HbA1c level (t = 2.7862, P = 0.0065) and left ventricular ejection fraction (LEVF) levels (t=3.2047, P = 0.0018). Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs, and age and γ-GGT level were risk factors (P < 0.05).


Serum TBIL levels are decreased and γ-GGT levels are increased in T2DM + ACS patients, and the two indices are significantly negatively correlated. TBIL and γ-GGT are independent influencing factors for MACEs in such patients.

Keywords: Acute coronary syndrome, Type-2 diabetes mellitus, Total bilirubin, Major adverse cardiovascular events

Core Tip: Serum total bilirubin (TBIL) and serum γ-glutamyltranspeptidase (γ-GGT) levels can be used as predictors of acute coronary syndrome (ACS) in patients with type-2 diabetes mellitus (T2DM). This study aims to investigate the levels and their correlations with major adverse cardiovascular events in T2DM patients with ACS. TBIL levels are found to be decreased and γ-GGT increased in T2DM + ACS patients, both of which can be used as indicators to assess patients’ condition and predict long-term adverse cardiovascular events in such patients.