Serum bilirubin subfractionation by high-performance liquid chromatography in patients with fulminant hepatic failure.

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Serum bilirubin subfractionation, using high-performance liquid chromatography (HPLC), was carried out and clinically evaluated in 9 patients with fulminant hepatic failure (FHF). Serum unconjugated bilirubin (UCB), C-8 bilirubin monoconjugate (MBC), C-12BMC and bilirubin diconjugate (BDC) were quantified by the alkaline methanolysis-HPLC method described by Blanckaert. Similar studies were performed in 10 patients with acute hepatitis (AH) and 6 patients with obstructive jaundice and the results were compared.In patients with rising serum bilirubin, the serum C-12BMC/C-8BMC ratio was calculated to be as follows: 2.10±0.21 for FHF, 1.05±0.34 for AH and 0.81±0.08 for obstructive jaundice, respectively. A significant differences were observed between FHF and All (P<0.01). As there was almost no overalapping, it was considered that this determination is useful for the differential diagnosis of jaundiced patients, especially, in those patients with AH whose sera show a prolonged prothrombin time lower than 40%, and there is a concern that they may develop FHF. The calculation of C-12BMC/C-8BMC allows us to make a differential diagnosis between AH and FHF at an early period in the development of the disease, and it was proved that serum C-12BMC/C-8BMC ratio can reflect the magnitude of hepatocyte damage as well as bilirubin metabolism disturbance.
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