Wang Ruoran, Luo Hongying, Xu Jianguo, He Min
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Operating Room, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China.
Curr Neurovasc Res. 2025;21(5):537-544. doi: 10.2174/0115672026365408241230061133.
Bilirubin plays a crucial role in the pathophysiological processes of strokes. However, the relationship between serum bilirubin levels and the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) remains unexplored. This study aims to investigate the association between serum bilirubin levels and the mortality rate of aSAH patients.
695 aSAH patients were included to analyze the relationship between direct bilirubin (DBil), indirect bilirubin (IDBil), total bilirubin (TBil), and mortality. The univariate and multivariate logistic regression were conducted to discover risk factors for the mortality of aSAH. The restricted cubic spline (RCS) was used to show the correlation between DBil, IDBil, TBil, and mortality. A logistic regression predictive model was developed by incorporating significant factors in the multivariate logistic regression. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of serum bilirubin and the developed predictive model.
139 aSAH patients suffered death, with a mortality of 20.0%. Non-survivors had older age (p =0.007), lower GCS (p <0.001), higher Hunt Hess (p <0.001), and mFisher (p <0.001). Both DBil (p <0.001) and TBil (p =0.011) were significantly higher among non-survivors. While the IDBil did not show a difference between survivors and non-survivors. The multivariate analysis found age (p =0.111), Glasgow Coma Scale (p =0.005), white blood cell (p <0.001), glucose (p =0.004), DBil (p =0.001), delayed cerebral ischemia (p <0.001) were significantly related with the mortality of aSAH. A logistic regression predictive model for mortality was developed incorporating these five factors, which had an area under the ROC curve (AUC) of 0.876. The AUC of DBil, IDBil, and TBil for predicting mortality was 0.607, 0.570, and 0.529, respectively.
Serum DBil level is positively associated with the mortality risk of aSAH. The predictive model incorporating DBil is beneficial for clinicians to evaluate the mortality risk of aSAH and adopt personalized therapeutics.
胆红素在中风的病理生理过程中起关键作用。然而，血清胆红素水平与动脉瘤性蛛网膜下腔出血（aSAH）预后之间的关系仍未得到探索。本研究旨在调查血清胆红素水平与aSAH患者死亡率之间的关联。
纳入695例aSAH患者，分析直接胆红素（DBil）、间接胆红素（IDBil）、总胆红素（TBil）与死亡率之间的关系。进行单因素和多因素逻辑回归以发现aSAH死亡率的危险因素。使用受限立方样条（RCS）来显示DBil、IDBil、TBil与死亡率之间的相关性。通过纳入多因素逻辑回归中的显著因素建立逻辑回归预测模型。绘制受试者工作特征（ROC）曲线以评估血清胆红素和所建立预测模型的预测价值。
139例aSAH患者死亡，死亡率为20.0%。非幸存者年龄较大（p =0.007），格拉斯哥昏迷量表（GCS）评分较低（p <0.001），Hunt Hess分级较高（p <0.001），mFisher分级较高（p <0.001）。非幸存者的DBil（p <0.001）和TBil（p =0.011）均显著更高。而IDBil在幸存者和非幸存者之间未显示出差异。多因素分析发现年龄（p =0.111）、格拉斯哥昏迷量表（p =0.005）、白细胞（p <0.001）、血糖（p =0.004）、DBil（p =0.001）、迟发性脑缺血（p <0.001）与aSAH的死亡率显著相关。纳入这五个因素建立了死亡率的逻辑回归预测模型，其ROC曲线下面积（AUC）为0.876。DBil、IDBil和TBil预测死亡率的AUC分别为0.607、0.570和0.529。
血清DBil水平与aSAH的死亡风险呈正相关。纳入DBil的预测模型有助于临床医生评估aSAH的死亡风险并采取个性化治疗。
