High syrum, billy reuben, is a good marker for liver injury and also a good marker of outcome as well. So the higher the billyreuben, the worse the prognosis for the liver injury,. ecause it it's a function of the liver, yes. But in saying that, the absence of billyReuben doesn't mean there is no liver injury. It could be impaired hpeto cellular up take or impaired conjugation. Could be impaired excretion out of the liver. Yes, you could break that into three parts, before the liver problem, yes, intra yes. hyper billy Reuben mia: Over production through excessive hemoglobin