Factors determining D-bilirubin levels in infants with biliary atresia

Wen Ye*, Philip Rosenthal, John C. Magee, Peter F. Whitington

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: d-Bilirubin (Bd) forms when bilirubin conjugates covalently bind to albumin by way of nonenzymatic transesterification in patients with cholestasis. Infants with cholestasis with biliary atresia form Bd. The aim of the present study was to investigate the factors determining serum Bd concentrations in infants with biliary atresia. Methods: Study patients were infants enrolled in a prospective study (PROBE: Clinicaltrials.gov NCT00061828) of biliary atresia. We acquired data of concurrently measured serum bilirubin analytes (total bilirubin [TB], conjugated bilirubin [Bc], and unconjugated bilirubin) and applied graphical methods and linear mixed effects model to study factors contributing to Bd variability. Results: Bd level increased with increasing levels of Bc and TB. In addition, the length of time cholestasis persisted partially determined the level of Bd. An increase of 1 mg/dL in Bc is related to approximately 0.36 mg/dL increase in Bd (P < 0.0001); every 100 days of cholestasis is associated with an approximately 1.0 mg/dL increase in Bd (P < 0.0001) given the same level of Bc. Serum albumin levels are not significantly related to Bd (P ¼ 0.89). Conclusions: Bd levels in infants with biliary atresia increase with increasing levels of Bc and longer duration of cholestasis. Understanding the relation among Bd, Bc, TB, and direct-reacting bilirubin levels can help in interpretation of the clinical extent of cholestasis in infants and children with biliary atresia, assisting in the diagnosis and management of these infants.

Original languageEnglish (US)
Pages (from-to)659-663
Number of pages5
JournalJournal of pediatric gastroenterology and nutrition
Issue number5
StatePublished - May 2015


  • Biliary atresia
  • Conjugated bilirubin
  • D-bilirubin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Fingerprint Dive into the research topics of 'Factors determining D-bilirubin levels in infants with biliary atresia'. Together they form a unique fingerprint.

Cite this