Serum TBA is used to assess liver dysfunction, which is not detected by conventional liver screening tests, which correspond to liver damage rather than liver function. The sensitivity of TBA allows earlier detection of liver malfunction, which in turn results in rapid treatment and prevention of extensive and irreversible liver damage. [4,6,11,25-26]
Studies showed that fasting serum TBA concentration were above normal range in hepatobiliary disease, such as chronic active hepatitis and liver cirrhosis while bilirubin values were still within the reference range [6, 25]. In addition, one of the studies found that fasting serum TBA values were elevated in patients with liver cirrhosis, while transaminase showed normal values .
The determination of TBA levels in pregnant women is considered to be the most important biomarker for diagnosis and monitoring of Intrahepatic Cholestasis of Pregnancy (ICP). TBA measurement proved a higher clinical relevance for diagnosis and surveillance of ICP than determination of alanine aminotransferase levels. 
Regarding treatment monitoring, a study confirmed that TBA measurement was superior in monitoring the progress of viral hepatitis, because serum TBA levels were elevated longer than bilirubin, alkaline phosphatase and AST .
Another study demonstrated that elevated serum TBA level is an early indicator for acute rejection and monitoring for antirejection therapy after liver transplantation. Bilirubin and transaminases were not suitable to detect acute rejection. 
Changes in serum TBA concentration provides information on effectiveness of interferon treatment in chronic hepatitis C patients, that changes in other liver function tests did not show .