ArticleFrontiers in endocrinology2026
Prognostic value of serum total bilirubin-lipid ratios in patients with IgA nephropathy.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reliable prognostic biomarkers are needed for IgA nephropathy (IgAN), a common glomerular disease frequently progressing to end-stage renal disease (ESRD). Given bilirubin's antioxidant and dyslipidemia's pro-inflammatory roles, we hypothesized that TBIL-lipid ratios would serve as novel composite biomarkers associated with renal outcomes in IgAN. Methods: We evaluated four serum bilirubin-lipid ratios (TBIL/Triglyceride, TBIL/Cholesterol, TBIL/HDL, TBIL/LDL) using Cox regression, restricted cubic spline (RCS), and linear mixed-effects (LME) models in biopsy-proven IgAN patients. Results: Of the 1352 patients included in this study, 283 (20.93%) developed composite renal outcome (≥30% decline in estimated glomerular filtration rate [eGFR] or ESRD). Multivariable Cox analysis showed that all four ratios were independently associated with reduced outcome risk: TBIL/Triglyceride (HR = 0.972, P = 0.025), TBIL/Cholesterol (HR = 0.849, P = 0.003), TBIL/HDL (HR = 0.970, P = 0.030), and TBIL/LDL (HR = 0.926, P = 0.004). Although the proportional hazards assumption was violated (all P < 0.05), time-dependent and piecewise Cox models confirmed that the protective effects remained significant in the early phase (≤3.13 years) but attenuated thereafter. RCS analyses demonstrated linear inverse associations for TBIL/Triglyceride, TBIL/Cholesterol, and TBIL/HDL, whereas TBIL/LDL exhibited a threshold-saturation pattern. These associations were more pronounced in those with advanced tubulointerstitial lesions (Oxford T1/T2). In LME models, all four ratios were positively associated with longitudinal eGFR levels (TBIL/Triglyceride: Estimate = 0.318, P = 0.002; TBIL/Cholesterol: Estimate = 1.242, P = 0.004; TBIL/HDL: Estimate = 0.289, P = 0.007; TBIL/LDL: Estimate = 0.446, P = 0.031), with associations remaining stable during follow-up. Conclusion: Higher serum bilirubin-lipid ratios, particularly TBIL/Cholesterol, were independently associated with lower risk of adverse renal outcomes and better preserved renal function in IgAN patients. These readily available biomarkers may provide additional value for risk stratification in clinical practice.
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