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
Research background

To provide more credible clinical evidence for the prognostic assessment of type-2 diabetes mellitus (T2DM) patients complicated with acute coronary syndrome (ACS) and a theoretical basis for early clinical intervention in the future.

Research motivation

Serum total bilirubin (TBIL) levels and γ-glutamyltranspeptidase (γ-GGT) levels can be used as indicators to assess patients’ condition and predict long-term adverse cardiovascular events in T2DM patients with ACS.

Research objectives

T2DM + ACS patients were found to have higher γ-GGT, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) levels than patients with T2DM or ACS alone, with significantly lower levels of TBIL and high-density lipoprotein cholesterol (HDL-C). In addition, serum TBIL was found to be inversely associated with γ-GGT, TC, LDL-C and HbAlc, but it had no correlation with triacylglycerol and HDL-C. Through univariate and multivariate logistic analyses, age, left ventricular ejection fraction (LEVF), serum TBIL levels, and serum γ-GGT levels were confirmed as independent influencing factors of ACS in T2DM patients, of which TBIL and LVEF levels were protective factors, and age and γ-GGT levels were risk factors.

Research methods

The clinical data of inpatients 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 general data and laboratory indexes were compared among the three groups, and the correlations of serum TBIL and γ-GGT levels with other indicators were evaluated. T2DM + ACS patients received a 90-day follow-up after discharge and were further divided into event (n = 15) and nonevent (n = 81) groups according to the occurrence of major adverse cardiovascular events (MACEs). Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.

Research results

There is still a lack of reliable indicators to evaluate the progression of T2DM complicated with ACS, and a great breakthrough has not been made in improving patient prognosis. Therefore, it is necessary to seek ideal markers to provide a basis for clinical diagnosis and treatment.

Research conclusions

By studying changes in serum TBIL and γ-GGT levels in T2DM patients complicated with ACS and exploring their correlations with MACEs, it is confirmed that serum levels of TBIL and γ-GGT can be used to assess patients’ condition and predict long-term MACEs in such patients.

Research perspectives

Cardiovascular disease is one of the major complications of diabetes, causing 50%-80% of early deaths. According to related research, ACS often occurs in patients with diabetes rather than nondiabetic patients.