ImplicatIions of bilirubin testing and the prevalence of abnormal liver function tests among rural adults in Mae Ka Subdistrict, Chiang Mai, Thailand

Background: Liver function tests (LFTs) measure the levels of specific enzymes and proteins in the blood that can change when the liver is damaged. Bilirubin, a byproduct of heme degradation, primarily from red blood cell breakdown (approximately 80%), is commonly included in these assessments. Although bilirubin and liver enzymes are well-established markers of liver function, they do not always indicate the presence of liver lesions. Therefore, for accurate diagnosis, changes in liver enzyme and bilirubin concentrations should be interpreted in the context of baseline characteristics such as pesticide exposure, alcohol consumption, and medication use. Objectives: To investigate the prevalence of abnormal LFTs and alterations in bilirubin concentrations among adults in Mae Ka Subdistrict, Chiang Mai, Thailand. Materials and methods: A descriptive cross-sectional study was conducted at the Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, from January to March 2024. Adults from Mae Ka Subdistrict participated in the study. A total of 102 subjects, aged 23 to 75 years (mean age 56.88±11.26 years), were included. Liver function tests, including ALT, AST, ALP, ALB, total bilirubin, and direct bilirubin, were performed using an automated analyzer (BA 400). The ALBI score and Pearson correlation were used to evaluate the relationships between liver enzymes, bilirubin levels, and baseline characteristics. A p≤ 0.05 was considered statistically significant. Data analysis was performed using SPSS version 17 and Microsoft Excel. Results: A strong correlation was observed between the use of medications for diabetes mellitus, hypertension, or hyperlipidemia and abnormal LFTs. Medication use was associated with elevations in total bilirubin (TB), ALBI score, ALT, and ALP. However, not all individuals with elevated bilirubin levels had abnormal liver enzymes, and not all individuals with abnormal liver enzymes had elevated bilirubin levels. The ALBI score identified two individuals with normal liver enzyme and albumin (ALB) levels who may require closer monitoring and further investigation for potential liver disease. Conclusion: Medication use was associated with abnormal LFTs, potentially serving as an early warning sign. The underlying non-communicable diseases (NCDs) that necessitate medication use may be the primary contributors. Early diagnosis and treatment of liver disease, along with prevention of NCDs and metabolic syndrome, may improve health outcomes in this community.