Biomarkers · Liver & Nutritional

Serum Total Bilirubin

Higher values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 8% lower risk of death. We found the same pattern in NHANES

Serum Total Bilirubin and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)0.92×95% CI 0.90–0.95 · 43,791 adults, 5,898 deaths

Published risk of death0.97×per 0.1-mg/dL increase in bilirubin (men; women 'very similar') (95% CI 0.97–0.98) · UK primary care (THIN) adults with bilirubin recorded and no hepatobiliary or hemolytic disease, 1988-2008

Value of the measurement+0.005gain in concordance within age bands; rank 51 of 56 · all tests

Serum Total Bilirubin by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mg/dL), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	0.20	0.30	0.40	0.60	1.10	1,431	NHANES 2017-2018
All	40-59	0.20	0.30	0.40	0.60	1.10	1,548	NHANES 2017-2018
All	60+	0.20	0.30	0.40	0.60	0.90	1,890	NHANES 2017-2018
All	all	0.20	0.30	0.40	0.60	1.00	4,869	NHANES 2017-2018
Men	20-39	0.20	0.30	0.50	0.70	1.20	684	NHANES 2017-2018
Men	40-59	0.20	0.30	0.50	0.60	1.20	723	NHANES 2017-2018
Men	60+	0.20	0.40	0.50	0.70	1.10	958	NHANES 2017-2018
Men	all	0.20	0.30	0.50	0.70	1.20	2,365	NHANES 2017-2018
Women	20-39	0.10	0.20	0.30	0.50	0.80	747	NHANES 2017-2018
Women	40-59	0.20	0.20	0.30	0.50	0.80	825	NHANES 2017-2018
Women	60+	0.20	0.30	0.40	0.50	0.80	932	NHANES 2017-2018
Women	all	0.20	0.20	0.30	0.50	0.80	2,504	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
clinical	Endoscopic biliary drainage (stenting) in extrahepatic biliary obstruction	After endoscopic drainage, 80.2% achieved ≥ 50% bilirubin reduction by day 7 and 70.3% reached bilirubin < 3 mg/dL by day 15	prospective cohort	Naidu KSC, et al. Reduction of serum bilirubin levels after endoscopic biliary…
exercise	Regular aerobic exercise habit	Habitual aerobic exercisers had higher total serum bilirubin than non-exercisers (0.78 vs 0.74 mg/dl; n=8290)	cross-sectional	Tani S, et al. Bilirubin may mediate the anti-inflammatory effects of aerobic…
physiological	Mild benign hyperbilirubinemia (Gilbert syndrome phenotype / UGT1A1*28)	Gilbert syndrome: higher bilirubin and lower IHD prevalence, 2% vs 12.1% in the general population (P<0.05)	cross-sectional	Vitek L, et al. Atherosclerosis. 2002;160:449-456.

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
clinical	Decompensated liver cirrhosis with acute-on-chronic liver failure	Liver failure in decompensated cirrhosis (ACLF) defined by total bilirubin ≥12 mg/dL; independently predicted severe course	prospective cohort	Gustot T, et al. Clinical Course of acute-on-chronic liver failure syndrome and…
clinical	Severe warm autoimmune hemolytic anemia	Increased indirect serum bilirubin frequently present (effect size not reported)	review	Packman CH. Hemolytic anemia due to warm autoantibodies. Blood Rev…

Sources

Risk curve: Horsfall 2011 (PMID 21325185): all-cause RR 0.97 (0.97-0.98) per 0.1-mg/dL increase in bilirubin (men; women 'very similar'). Scaled to US values (NHANES).
Horsfall et al. Serum bilirubin and risk of respiratory disease and death. JAMA. 2011;305:691-7.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Serum Total Bilirubin against another biomarker.

Map Serum Total Bilirubin against another marker