Impact of elevated direct bilirubin levels on the measurement of unbound bilirubin
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View abstract on PubMed
Summary
This summary is machine-generated.In high-risk neonates, unbound bilirubin (UB) may be spuriously elevated with rising direct bilirubin (DB). Estimating UB from the indirect bilirubin (iDB) to albumin ratio offers a more reliable clinical assessment when DB is high.
Area Of Science
- Neonatal Medicine
- Clinical Chemistry
- Biochemistry
Background
- Elevated direct bilirubin (DB) is common in high-risk neonates (e.g., very low birth weight, post-abdominal surgery).
- Peroxidase-based analyzers may yield falsely high unbound bilirubin (UB) readings in these infants, hindering accurate clinical interpretation.
Purpose Of The Study
- To investigate the relationship between direct bilirubin (DB) levels and unbound bilirubin (UB) measurements in neonates.
- To determine if the indirect bilirubin (iDB) to albumin ratio can serve as a reliable alternative for UB assessment when DB is elevated.
Main Methods
- Retrospective analysis of 5970 neonatal laboratory datasets (Jan 2021-Dec 2023).
- Enzymatic DB measurement; iDB calculated as TB minus DB.
- Correlation analysis between iDB/albumin ratio and UB across varying DB levels and DB/TB ratios.
Main Results
- Correlation between iDB/albumin and UB weakened as DB levels and DB/TB ratios increased.
- Spurious elevations in UB were noted: 32.5% of cases with DB 2-3 mg/dL and 92.2% with DB ≥3 mg/dL showed outlier-high UB.
- Significant outlier-high UB rates were also observed with DB/TB ratios ≥20% (17.2%) and ≥30% (51.7%).
Conclusions
- Unbound bilirubin (UB) measurements can be spuriously elevated in neonates with increasing direct bilirubin (DB), especially when DB ≥2 mg/dL or DB/TB ≥20%.
- The indirect bilirubin (iDB) to albumin ratio provides a more dependable estimation of UB in these clinical scenarios, aiding in accurate risk assessment.
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