Biomarkers · Liver & Nutritional
Serum Total Bilirubin
U-shaped: both low and high values carry risk. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation is associated with a hazard ratio of 0.92. U-shaped: slope not comparable
NHANES, our fit with 95% CIPublished curve
Hazard ratios 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.
NHANES hazard per SD0.9295% CI 0.90–0.95 · 43,791 adults, 5,898 deaths
Published hazard ratio0.84per SD (95% CI 0.77–0.91) · THIN UK Primary Care Cohort
Where people sit
Population percentiles (mg/dL) by sex and age band. Cycle or source as recorded in the catalogue.
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 0.27 | 0.43 | 0.58 | 0.78 | 1.22 | 2,700 | 2017-2018 |
| All | 40-59 | 0.28 | 0.44 | 0.60 | 0.80 | 1.25 | 2,650 | 2017-2018 |
| All | 60+ | 0.30 | 0.46 | 0.62 | 0.83 | 1.30 | 2,800 | 2017-2018 |
| All | all | 0.28 | 0.44 | 0.60 | 0.80 | 1.25 | 8,150 | 2017-2018 |
| Men | all | 0.34 | 0.51 | 0.69 | 0.90 | 1.38 | 3,950 | 2017-2018 |
| Women | all | 0.25 | 0.40 | 0.52 | 0.70 | 1.07 | 4,200 | 2017-2018 |
What studies found when this marker was changed
Effects on the biomarker reported in the cited studies. They describe what happened in those populations, not a recommendation for anyone. See all catalogued interventions.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | Biliary decompression and stent placement in obstructive jaundice | -60% to -90% rapid clearance in obstructive hyperbilirubinemia | clinical guideline | Dumonceau JM, et al. Endoscopy. 2018;50:910-930. |
| clinical | Decompensated liver cirrhosis or acute liver failure | +300% to +2000% toxic elevation (>3.0 mg/dL) | clinical guideline | Bernal W, et al. Lancet. 2010;376:190-201. |
| clinical | Severe intravascular autoimmune hemolytic anemia | +150% to +500% indirect bilirubin elevation | systematic review | Packman CH. Blood Rev. 2008;22:1-16. |
| exercise | Regular moderate aerobic exercise and maintenance of healthy body composition | Optimizes physiologic bilirubin in protective 0.6-1.1 mg/dL range | cohort | National Center for Health Statistics. National Health and Nutrition Examination… |
| lifestyle | Moderate aerobic exercise conditioning and dietary zinc optimization | Preserves optimal physiological 0.6-0.9 mg/dL antioxidant level | meta-analysis | Horsfall LJ, et al. J Am Heart Assoc. 2014;3:e001087. |
| physiological | Mild benign hyperbilirubinemia (Gilbert syndrome phenotype / UGT1A1*28) | +0.4 to +0.8 mg/dL physiological elevation confers cardiovascular protection | prospective cohort | Vitek L, et al. Atherosclerosis. 2002;160:449-456. |
Sources
- Hazard curve: PLoS One 2017; 12:e0176317
- Horsfall LJ, et al. Serum bilirubin and risk of cardiovascular disease, cancer, and mortality: a cohort study in UK primary care. Lancet. 2011;377(9763):414-420.
- Empirical curve: our Cox model with age and sex, NHANES 1999–2018 with linked mortality to 2019.