Department of Rehabilitation Medicine, The Second Hospital of Shandong University, 247# Beiyuan Street, Jinan, 250033, Shandong, China.
Department of Rehabilitation Medicine, Yu Huang Ding Hospital, Yantai, Shandong, China.
Sci Rep. 2024 Aug 29;14(1):20071. doi: 10.1038/s41598-024-71124-9.
Accurate prediction of the recovery of Disorders of Consciousness (DoC) is of paramount significance for clinicians and families. Serum total bilirubin (TBIL) formed by activation of heme oxygenase 2, is associated with incidence and prognosis of cardiovascular and cerebrovascular diseases. However, studies that based TBIL and DoC are limited. The study attempted to examine the association between serum TBIL levels and prognosis in patients with DoC. One hundred and sixty-eight patients with DoC in the Second hospital of Shandong University from June 2021 to June 2023 were recruited. The clinical characteristics and venous blood samples were collected within 24 h after admission. The diagnosis of DoC was determined by two skilled investigators employing various behavioral evaluations along the coma recovery scale-revised (CRS-R) and the investigators conducted follow-up assessments of diagnosis at 1, 3, and 6 months after admission. For statistical analysis, we categorized patients with an improvement in clinical diagnosis from study entry as having a "good outcome". In total, 139 individuals enrolled in the study. The median TBIL level was 8.2 μmol/L. Good recovery of DoC at 1, 3, and 6 months occurred in 25 (18.0%), 41 (29.5%), and 56 (40.3%) patients, respectively. After full adjustment, a significant association was found between TBIL levels and the prognosis of DoC at 1, 3, and 6 months. When TBIL levels were analyzed as categorical variables, an increasing trend in the tertiles of TBIL levels demonstrated a significant positive association with the recovery of DoC at 1, 3, and 6 months. Stratified analysis revealed that the association between serum TBIL levels and the recovery of DoC remained consistent across different sub-populations. A high serum TBIL level is associated with an improved likelihood of recovery of DoC. Additional research is required to elucidate the underlying pathophysiological causal association between TBIL levels and DoC.
准确预测意识障碍（DOC）的恢复对于临床医生和患者家属至关重要。血红素加氧酶 2 激活形成的血清总胆红素（TBIL）与心血管和脑血管疾病的发病率和预后相关。然而，基于 TBIL 和 DOC 的研究有限。本研究试图探讨血清 TBIL 水平与 DOC 患者预后的关系。纳入 2021 年 6 月至 2023 年 6 月期间在山东大学第二医院就诊的 168 例 DOC 患者，在入院后 24 h 内采集临床特征和静脉血样本。两名熟练的研究者采用昏迷恢复量表修订版（CRS-R）等各种行为评估方法确定 DOC 的诊断，并在入院后 1、3 和 6 个月对诊断进行随访评估。对于统计分析，我们将临床诊断改善的患者分为“预后良好”。共有 139 名患者入组研究。TBIL 中位数为 8.2 μmol/L。1、3 和 6 个月时 DOC 的良好恢复分别发生在 25 例（18.0%）、41 例（29.5%）和 56 例（40.3%）患者中。在充分调整后，TBIL 水平与 1、3 和 6 个月时 DOC 的预后之间存在显著关联。当 TBIL 水平作为分类变量进行分析时，TBIL 水平三分位数的升高趋势与 1、3 和 6 个月时 DOC 的恢复呈显著正相关。分层分析表明，血清 TBIL 水平与 DOC 恢复之间的关联在不同亚人群中保持一致。高血清 TBIL 水平与提高 DOC 恢复的可能性相关。需要进一步研究阐明 TBIL 水平与 DOC 之间潜在的病理生理因果关联。
