Are unexpected positive dipstick urine bilirubin results clinically significant? A retrospective review

Urine-bilirubin measurement is common in urinalysis dipsticks, which are known to yield a high rate of false positive results. We evaluated the usefulness of this test after multiple physicians in our system reported that they do not act on positive dipstick urine bilirubin findings.

We queried past records to determine how many samples with positive urine bilirubin results had associated abnormal results for liver function tests (LFTs) within 2 weeks before the positive urine bilirubin result. (LFTs included aspartate aminotransferase [AST], alanine transaminase [ALT], gamma-glutamyl transpeptidase [GGT], and total bilirubin.) We labeled positive results on these test as expected positives. We labeled the positive test results for samples from patients who had not had abnormal LFT results within 2 weeks before the current testing as unexpected positives.

During a 20-month period, we performed 241,929 urine-bilirubin tests. Of these, 831 (0.3%) yielded positive results. Of these positives, 60% were from patients who had abnormal LFT results in the previous 2 weeks. The remaining 40% of positive results were deemed to be unexpected positives. Of these, 80% had had LFTs ordered within 2 weeks after the positive urine bilirubin results. A total of 85% of those LFTs yielded an abnormal result.

In patients with an unexpected positive urine bilirubin test result, 85% had abnormal LFT results after their positive urine bilirubin result. However, these unexpected positives amounted to only 0.13% of all test results. Urine bilirubin does not appear to add significant information toward the diagnosis of most patients.