Can the icteric index be used instead of total bilirubin in addition to being a preanalytical marker? Icteric index in the laboratory

The icteric index (I-index) is a practical and low-cost method for screening hyperbilirubinemia and potentially reducing unnecessary total bilirubin (TBil) testing. This study was designed to determine a safe I-index to detect TBil above the upper reference range to avoid unnecessary TBil orders. Th...

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Vydáno v:Practical laboratory medicine Ročník 47; s. e00509
Hlavní autoři: Odabasi, Merve Sena, Yalcinkaya Kara, Zeynep Mine
Médium: Journal Article
Jazyk:angličtina
Vydáno: Netherlands Elsevier B.V 01.12.2025
Elsevier
Témata:
Icteric index
Preanalytical indicator
Total bilirubin
Icteric index
Preanalytical indicator
Total bilirubin
ISSN:2352-5517, 2352-5517
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Shrnutí:The icteric index (I-index) is a practical and low-cost method for screening hyperbilirubinemia and potentially reducing unnecessary total bilirubin (TBil) testing. This study was designed to determine a safe I-index to detect TBil above the upper reference range to avoid unnecessary TBil orders. The reflexive addition of TBil in samples where I-index is above the cut-off value and TBil measurement is not initially planned will be a secondary gain of the study. This study included 267185 samples with TBil test results and corresponding I-index values. TBil and I-index values were measured with the Roche Cobas 8000 (c701) and Cobas 6000 (c501) analyzers. Statistical analyses were performed using SPSS 15.0, with ROC curve analysis used to determine the optimal I-index cut-off for TBil screening. An I-index cut-off of 34.2 μmol/L provided the lowest false negativity (0.45 %), highest specificity (97.1 %), and negative predictive value (99.5 %). Using this cut-off point, if we had reached 100 % NPV, 87.4 % of TBil tests in the group receiving inpatient/outpatient treatment with Cobas-8000 and 89.8 % in the emergency group with Cobas 6000 could have been saved. This is the study with the largest sample size. The sample size is critical in determining a reliable I-index cut-off point. We conclude that I-index should not replace TBil since the NPV was not 100 %; however, it seems reasonable to reflexively add TBil testing in samples where the I-index is above the cut-off value and TBil measurement was not initially planned. •This is the largest sample size study on the use of the I-index in TBil screening.•I-index cannot replace the analytical measurement of the TBil test.•Add TBil in samples with abnormal I-index for which TBil was not initially requested.
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ISSN:2352-5517
2352-5517
DOI:10.1016/j.plabm.2025.e00509