Conjugated bilirubin in chronic liver disease: an underutilised prognostic biomarker?

Chronic liver disease (CLD) is a major global health burden, often progressing to cirrhosis, decompensation, and hepatocellular carcinoma. Prognostic models typically rely on serum total bilirubin. However, recent evidence suggests that conjugated bilirubin (CB) may offer superior prognostic utility in assessing disease severity and outcomes in CLD. This mini review examines the emerging evidence supporting CB as a prognostic and disease stratification biomarker across various clinical contexts, where it has demonstrated enhanced predictive accuracy over traditional measures. Elevated CB may reflect impaired hepatocyte excretory function and fibrosis-related biliary obstruction, while emerging evidence suggests that hepatocyte senescence could provide an additional biologically relevant mechanistic explanation. Incorporating CB into clinical models may therefore improve risk stratification and guide clinical decision-making. Further validation and mechanistic studies are needed to establish CB as a standard component in the prognostic assessment of CLD