{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:29:07Z","timestamp":1789475347845,"version":"build-2803163510"},"reference-count":23,"publisher":"Croatian Society for Medical Biochemistry and Laboratory Medicine","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biochem. med. (Online)"],"published-print":{"date-parts":[[2021,6,15]]},"abstract":"<jats:p>Total bilirubin tests are highly demanded in clinical laboratories. Since icteric index (I-index) has zero cost, we aimed to evaluate its clinical utility and cost-effectiveness to determine if total bilirubin is necessary to be tested. We took into account if haemolysis could interfere to icteric index determination.\nRetrospectively we reviewed I-index results in two cohorts (43,372 and 8507 non-haemolysed and haemolysed samples, respectively). All determinations were done using Alinity c chemistry analysers (Abbott Diagnostics). Receiver operating characteristic (ROC) curve was used to determine the optimal index cut-off to discriminate between normal and abnormal bilirubin concentration (20.5 \u00b5mol\/L).\nThe ROC curve analysis suggested 21.4 \u00b5mol\/L as the optimal I-index cut-off but differences in sensitivity and specificity were detected between patient derivation. For rejecting purpose, 15.4 \u00b5mol\/L and 17.1 \u00b5mol\/L I-index thresholds were selected based on patient derivation (inpatients and emergency room; and primary care and outpatients, respectively) with 97% sensitivity and 0.25% false negative results. Sensitivity was much lower in haemolysed samples. We selected 34.2 \u00b5mol\/L I-index as threshold to detect hyperbilirubinemia with 99.7% specificity and 0.26% false positive results, independent of haemolysis. With the icteric index cut-offs proposed, we would save 66% of total bilirubin requested and analyse total bilirubin in around 2% of samples without total bilirubin requested.\nThis study supports the use of I-index to avoid bilirubin determination and to identify patients with hyperbilirubinemia. This work considers that the economic and test savings could help to increase the efficiency in clinical laboratories.<\/jats:p>","DOI":"10.11613\/bm.2021.020703","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T11:22:06Z","timestamp":1618399326000},"page":"258-266","source":"Crossref","is-referenced-by-count":9,"title":["Utility of icteric index in clinical laboratories: more than a preanalytical indicator"],"prefix":"10.11613","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6641-2073","authenticated-orcid":false,"given":"Rufino","family":"Mondejar","sequence":"first","affiliation":[{"name":"UGC Laboratory"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Mayor Reyes","sequence":"additional","affiliation":[{"name":"UGC Laboratory"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Melguizo Madrid","sequence":"additional","affiliation":[{"name":"UGC Laboratory"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Consuelo","family":"Ca\u00f1avate Solano","sequence":"additional","affiliation":[{"name":"UGC Laboratory"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"P\u00e9rez Ramos","sequence":"additional","affiliation":[{"name":"UGC Laboratory"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4885","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"key20210414071956_r1"},{"key":"key20210414071956_r2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/bs.acc.2015.05.002","article-title":"Systematic Assessment of the Hemolysis Index: Pros and Cons.","volume":"71","author":"Lippi","year":"2015","journal-title":"Adv Clin Chem"},{"key":"key20210414071956_r3","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1177\/0004563216643557","article-title":"Serum indices: managing assay interference.","volume":"53","author":"Farrell","year":"2016","journal-title":"Ann Clin Biochem"},{"key":"key20210414071956_r4","first-page":"143","article-title":"Current Methods of Haemolysis Detection and Reporting as a Source of Risk to Patient Safety: a Narrative Review.","volume":"37","author":"McCaughey","year":"2016","journal-title":"Clin Biochem Rev"},{"key":"key20210414071956_r5","doi-asserted-by":"crossref","first-page":"307","DOI":"10.3343\/alm.2014.34.4.307","article-title":"Development of an integrated reporting system for verifying hemolysis, icterus, and lipaemia in clinical chemistry results.","volume":"34","author":"Shin","year":"2014","journal-title":"Ann Lab Med"},{"key":"key20210414071956_r6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.cca.2015.07.006","article-title":"Developing optimized automated rule sets for reporting hemolysis, icterus and lipaemia based on a priori outcomes analysis.","volume":"450","author":"Boyd","year":"2015","journal-title":"Clin Chim Acta"},{"key":"key20210414071956_r7","doi-asserted-by":"crossref","first-page":"154","DOI":"10.11613\/BM.2010.018","article-title":"Hemolysis detection and management of hemolyzed specimens.","volume":"20","author":"Simundic","year":"2010","journal-title":"Biochem Med (Zagreb)"},{"key":"key20210414071956_r8","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1515\/cclm-2016-1064","article-title":"To report or not to report: a proposal on how to deal with altered test results in hemolytic samples.","volume":"55","author":"Cadamuro","year":"2017","journal-title":"Clin Chem Lab Med"},{"key":"key20210414071956_r9","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1515\/cclm-2017-0011","article-title":"Reporting altered test results in hemolyzed samples: is the cure worse than the disease?","volume":"55","author":"Lippi","year":"2017","journal-title":"Clin Chem Lab Med"},{"key":"key20210414071956_r10","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1515\/cclm-2017-1104","article-title":"Practical recommendations for managing hemolyzed samples in clinical chemistry testing.","volume":"56","author":"Lippi","year":"2018","journal-title":"Clin Chem Lab Med"},{"key":"key20210414071956_r11","article-title":"European survey on preanalytical sample handling - Part 2: Practices of European laboratories on monitoring and processing haemolytic, icteric and lipaemic samples. On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE).","volume":"29","author":"Cadamuro","year":"2019","journal-title":"Biochem Med (Zagreb)"},{"key":"key20210414071956_r12","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.14309\/ajg.0000000000000336","article-title":"Evaluating an Outpatient With an Elevated Bilirubin.","volume":"114","author":"M\u00e9ndez-S\u00e1nchez","year":"2019","journal-title":"Am J Gastroenterol"},{"key":"key20210414071956_r13","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1093\/ajcp\/aqy165","article-title":"The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries.","volume":"151","author":"Horton","year":"2019","journal-title":"Am J Clin Pathol"},{"key":"key20210414071956_r14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012799","article-title":"STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration.","volume":"6","author":"Cohen","year":"2016","journal-title":"BMJ Open"},{"key":"key20210414071956_r15","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1515\/cclm-2017-0889","article-title":"Precision, accuracy, cross reactivity and comparability of serum indices measurement on Abbott Architect c8000, Beckman Coulter AU5800 and Roche Cobas 6000 c501 clinical chemistry analyzers.","volume":"56","author":"Nikolac Gabaj","year":"2018","journal-title":"Clin Chem Lab Med"},{"key":"key20210414071956_r16","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1136\/jclinpath-2012-200811","article-title":"Diagnostic accuracy of icteric index to detect abnormal total bilirubin values.","volume":"65","author":"Salinas","year":"2012","journal-title":"J Clin Pathol"},{"key":"key20210414071956_r17","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1136\/jclinpath-2013-201544","article-title":"Measurement of icteric index as approach to detect abnormal total bilirubin values.","volume":"66","author":"Szoke","year":"2013","journal-title":"J Clin Pathol"},{"key":"key20210414071956_r18","first-page":"64","article-title":"Rivas Chac\u00f3n LdM, C\u00e1mara Hern\u00e1ndez V, de Paula Ruiz M, Pascual Dur\u00e1n T. Valoraci\u00f3n del uso del \u00edndice ict\u00e9rico como par\u00e1metro para la gesti\u00f3n de la determinaci\u00f3n de la bilirrubina total.","volume":"12","author":"Torrado Carri\u00f3n","year":"2019","journal-title":"Rev del Lab Clin."},{"key":"key20210414071956_r19","first-page":"270","article-title":"Suitability of icteric index (II) as front-line test for the identification of blood samples with abnormal total bilirubin (TB) concentrations.","volume":"39","author":"Pasqualetti","year":"2015","journal-title":"Biochim Clin"},{"key":"key20210414071956_r20","doi-asserted-by":"crossref","first-page":"e318","DOI":"10.1515\/cclm-2019-0193","article-title":"Utility of the icteric index for the management of bilirubin test requesting.","volume":"57","author":"Arbiol-Roca","year":"2019","journal-title":"Clin Chem Lab Med"},{"key":"key20210414071956_r21","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1515\/cclm-2019-0609","article-title":"Are icteric and lipaemic indices reliable to screen for Hyperbilirubinaemia and hypertriglyceridemia?","volume":"58","author":"Lippi","year":"2019","journal-title":"Clin Chem Lab Med"},{"key":"key20210414071956_r22","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.4067\/S0034-98872013001000005","article-title":"Prevalence of Gilbert syndrome and its genetic determinants in Chile.","volume":"141","author":"M\u00e9ndez","year":"2013","journal-title":"Rev Med Chil"},{"key":"key20210414071956_r23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12876-019-0931-2","article-title":"The frequency, clinical course, and health related quality of life in adults with Gilbert\u2019s syndrome: a longitudinal study.","volume":"19","author":"Kamal","year":"2019","journal-title":"BMC Gastroenterol"}],"container-title":["Biochemia medica"],"original-title":[],"link":[{"URL":"https:\/\/www.biochemia-medica.com\/en\/journal\/31\/2\/10.11613\/BM.2021.020703\/fullArticle","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T15:28:16Z","timestamp":1626708496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.biochemia-medica.com\/en\/journal\/31\/2\/10.11613\/BM.2021.020703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,15]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,6,15]]},"published-print":{"date-parts":[[2021,6,15]]}},"URL":"https:\/\/doi.org\/10.11613\/bm.2021.020703","relation":{},"ISSN":["1846-7482","1330-0962"],"issn-type":[{"value":"1846-7482","type":"electronic"},{"value":"1330-0962","type":"print"}],"subject":[],"published":{"date-parts":[[2021,6,15]]}}}