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Background <p>The association between serum total bilirubin (TBIL) levels and mortality in maintenance hemodialysis (MHD) patients, especially when stratified by age, has not been clearly established.</p> Methods <p>We performed a multicenter retrospective analysis of 409 MHD patients (40 deaths, 9.8%) over a median follow-up of 31.3 months (interquartile range (IQR), 28.9–31.8). Cox regression models evaluated TBIL’s predictive role for mortality. Receiver operating characteristic (ROC) curve-derived cutoff (8.79 µmol/L) stratified patients into high (H, TBIL &gt; 8.79 µmol/L, <i>n</i> = 236) and low (L, TBIL ≤ 8.79 µmol/L, <i>n</i> = 173) groups. Multivariable Cox models adjusted for demographics, comorbidities (Model 2), and laboratory markers (Model 3). Additionally, to mitigate overfitting and assess the linear relationship, a LASSO-penalized Cox model was employed, treating TBIL as a continuous variable. Kaplan-Meier analysis compared survival rates, with age subgroup comparisons.</p> Results <p>Significant differences emerged between H and L groups in hypertension history, platelet count, total protein, blood urea nitrogen, triglycerides, and total cholesterol (all <i>P</i> &lt; 0.05). Adjusted models revealed elevated mortality risk in high TBIL patients (HR = 6.92, 95%CI 3.10–15.43, <i>P</i> &lt; 0.001). Consistently, in the continuous analysis, each 1 µmol/L increase in TBIL was associated with a 26% increased mortality risk (HR = 1.26, 95%CI 1.16–1.38, <i>P</i> &lt; 0.001). Age-stratified analysis revealed substantially increased mortality risk in non-elderly high-TBIL patients (HR = 12.82, 95%CI 3.76–43.76, <i>P</i> &lt; 0.001), but no significant association in elderly patients (HR = 2.00, 95%CI 0.83–4.81, <i>P</i> = 0.12).</p> Conclusion <p>TBIL independently predicts all-cause mortality in MHD patients, with exploratory evidence suggesting potentially stronger association in non-elderly patients.</p>

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Total bilirubin as a mortality predictor in non-elderly hemodialysis patients: a multicenter retrospective cohort study

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  • 发表日期：

    2025年11月20日

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  • Yuyang Chen,
  • Haowen Zhang,
  • Hongyan Liu,
  • Jialong Zhang,
  • Xuan Dai,
  • Wenjing Dong,
  • Qingqing Liu,
  • Liping Zhu,
  • Yefan Zhang,
  • Xue Zhou,
  • Li Cheng,
  • Xiaoyan Lu,
  • Haixia Yang,
  • Qian Liu,
  • Jie Song,
  • Qian Li,
  • Jiarui Li,
  • Haihua Su,
  • Xinchao Tao,
  • Aijie Shi,
  • Pei Yu

摘要

Background

The association between serum total bilirubin (TBIL) levels and mortality in maintenance hemodialysis (MHD) patients, especially when stratified by age, has not been clearly established.

Methods

We performed a multicenter retrospective analysis of 409 MHD patients (40 deaths, 9.8%) over a median follow-up of 31.3 months (interquartile range (IQR), 28.9–31.8). Cox regression models evaluated TBIL’s predictive role for mortality. Receiver operating characteristic (ROC) curve-derived cutoff (8.79 µmol/L) stratified patients into high (H, TBIL > 8.79 µmol/L, n = 236) and low (L, TBIL ≤ 8.79 µmol/L, n = 173) groups. Multivariable Cox models adjusted for demographics, comorbidities (Model 2), and laboratory markers (Model 3). Additionally, to mitigate overfitting and assess the linear relationship, a LASSO-penalized Cox model was employed, treating TBIL as a continuous variable. Kaplan-Meier analysis compared survival rates, with age subgroup comparisons.

Results

Significant differences emerged between H and L groups in hypertension history, platelet count, total protein, blood urea nitrogen, triglycerides, and total cholesterol (all P < 0.05). Adjusted models revealed elevated mortality risk in high TBIL patients (HR = 6.92, 95%CI 3.10–15.43, P < 0.001). Consistently, in the continuous analysis, each 1 µmol/L increase in TBIL was associated with a 26% increased mortality risk (HR = 1.26, 95%CI 1.16–1.38, P < 0.001). Age-stratified analysis revealed substantially increased mortality risk in non-elderly high-TBIL patients (HR = 12.82, 95%CI 3.76–43.76, P < 0.001), but no significant association in elderly patients (HR = 2.00, 95%CI 0.83–4.81, P = 0.12).

Conclusion

TBIL independently predicts all-cause mortality in MHD patients, with exploratory evidence suggesting potentially stronger association in non-elderly patients.