{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:56:24Z","timestamp":1753869384651,"version":"3.41.2"},"reference-count":5,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T00:00:00Z","timestamp":1495152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2018,2]]},"abstract":"Background<\/jats:title>Total, unconjugated and conjugated bilirubin levels are usually ordered together in health check\u2010up populations. The aim of this study was to investigate whether using increased total bilirubin (TBIL<\/jats:styled-content>) as a reflex test can reduce conjugated bilirubin (CBIL<\/jats:styled-content>) test.<\/jats:p><\/jats:sec>Methods<\/jats:title>Medical records of 8433 males and 4496 females who visited Shuyang People's Hospital for health check\u2010ups were retrospectively reviewed and the fasting serum TBIL<\/jats:styled-content>, unconjugated bilirubin (UBIL<\/jats:styled-content>) and CBIL<\/jats:styled-content> of patients were extracted. Reference intervals for TBIL<\/jats:styled-content>, UBIL<\/jats:styled-content>, CBIL<\/jats:styled-content> and C\/TBIL<\/jats:styled-content> were established using Q2.5<\/jats:sub> to Q97.5<\/jats:sub>. The relationship between TBIL<\/jats:styled-content> and CBIL<\/jats:styled-content> was analyzed by Spearman's approach. Receiver operating characteristics (ROC<\/jats:styled-content>) curve analysis was used to evaluate the predictive accuracy of TBIL<\/jats:styled-content> for abnormal CBIL<\/jats:styled-content> and UBIL<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>The reference intervals for TBIL<\/jats:styled-content> in males and females were 6.9\u201029.3\u00a0\u03bcmol\/L and 6.1\u201023.8\u00a0\u03bcmol\/L, respectively. For CBIL<\/jats:styled-content>, the reference intervals were 1.9\u201010.4\u00a0\u03bcmol\/L and 1.6\u20108.8\u00a0\u03bcmol\/L for males and females, respectively. CBIL<\/jats:styled-content> was significantly positively correlated with TBIL<\/jats:styled-content>, either in males (r<\/jats:italic>=.75) or females (r<\/jats:italic>=.73). Area under curve (AUC<\/jats:styled-content>) of TBIL<\/jats:styled-content> for predicting abnormal CBIL<\/jats:styled-content> was 0.99 in both male and females. The optimal threshold of TBIL<\/jats:styled-content> for predicting abnormal CBIL<\/jats:styled-content> and UBIL<\/jats:styled-content> were 21.0\u00a0\u03bcmol\/L in males and 17.0\u00a0\u03bcmol\/L in females. At these thresholds, <2% of subjects with abnormal CBIL<\/jats:styled-content> or CBIL<\/jats:styled-content> might be missed, but approximately 87% of the CBIL<\/jats:styled-content> test could be eliminated.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Conjugated bilirubin measurement is not needed for the apparently healthy males with TBIL<\/jats:styled-content> <21.0\u00a0\u03bcmol\/L or females with TBIL<\/jats:styled-content> <17.0\u00a0\u03bcmol\/L.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcla.22233","type":"journal-article","created":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T06:16:57Z","timestamp":1495174617000},"source":"Crossref","is-referenced-by-count":4,"title":["Conjugated bilirubin as a reflex test for increased total bilirubin in apparently healthy population"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0662-1302","authenticated-orcid":false,"given":"Guo\u2010Ming","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine Shuyang People's Hospital Shuyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3679-4992","authenticated-orcid":false,"given":"Zhi\u2010De","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine the General Hospital of Ji'nan Military Command Region Ji'nan Shandong China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,5,19]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2008.01716.x"},{"issue":"2","key":"e_1_2_5_3_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/000456329102800202","article-title":"The analysis of bilirubin in serum","volume":"28","author":"Westwood A","year":"1991","journal-title":"Ann Clin Biochem"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/10408369109106872"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2016.09.005"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPO47VAWYRIDHG"}],"container-title":["Journal of Clinical Laboratory Analysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjcla.22233","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcla.22233","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T20:14:18Z","timestamp":1695759258000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jcla.22233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,19]]},"references-count":5,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1002\/jcla.22233"],"URL":"https:\/\/doi.org\/10.1002\/jcla.22233","archive":["Portico"],"relation":{},"ISSN":["0887-8013","1098-2825"],"issn-type":[{"type":"print","value":"0887-8013"},{"type":"electronic","value":"1098-2825"}],"subject":[],"published":{"date-parts":[[2017,5,19]]},"article-number":"e22233"}}