Association between chest pain and serum total bilirubin levels in adults

The association between serum total bilirubin (STB) and chest pain remains unclear. This study aimed to explore the potential relationship between STB and the prevalence of chest pain. Data from the National Health and Nutrition Examination Survey 2005 to 2018 were analyzed to evaluate the association between STB levels and chest pain. Logistic regression (odds ratio with 95% confidence interval), restricted cubic spline curves, and stratified subgroup analyses were performed, and a total of 19,187 participants were enrolled. STB was negatively correlated with chest pain; each unit increment in log ₂ (STB) corresponded to a 9% reduction in the risk of chest pain (odds ratio = 0.91, 95% confidence interval: 0.85–0.96, P  < .001). The restricted cubic spline curve revealed a nonlinear relationship between log ₂ (STB) and chest pain ( P for nonlinearity = .008), with an inflection point at 14.42 μmol/L. The association between STB and chest pain was consistent across multiple subgroups. Mildly elevated STB concentrations were associated with a lower prevalence of chest pain in our study population, suggesting that STB may have potential value for risk stratification of chest pain. Nevertheless, additional prospective studies are required to verify the causal relationship between them.