Shen Hui, Guo Wei, Zhang Jin, Mei Qing, Liu Aihua, Liu Jiachun
Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2025 May 13;16:1537585. doi: 10.3389/fneur.2025.1537585. eCollection 2025.
Non-traumatic subarachnoid hemorrhage (NTSAH), primarily caused by intracranial aneurysm rupture, represents a significant global health challenge due to its high mortality and morbidity. The leuko-glycemic index (LGI), a biomarker reflecting oxidative stress and inflammation, has been associated with adverse cardiovascular outcomes. However, its prognostic value in critically ill NTSAH patients remains uncertain. Understanding the relationship between LGI and patient outcomes is essential to improve clinical management of NTSAH.
We identified NTSAH patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 2.2) database. Participants were divided into quartiles based on their LGI scores. Mortality was evaluated at multiple time points: ICU stay, in-hospital, and at 1-, 6-, and 12-month post-admission. The association between LGI and mortality was examined using multivariate Cox proportional hazards regression. Restricted cubic spline (RCS) analysis was employed to delineate the relationship between LGI scores and mortality risk and to identify the cutoff value. The robustness of these findings were confirmed through subgroup analyses, interaction tests, and likelihood ratio tests.
A total of 750 patients were included, with 57% being female. Mortality rates were 17% in the ICU, 20% in-hospital, 21% at 1 month, 27% at 6 months, and 29% at 1 year. Multivariate Cox regression analysis revealed that higher LGI score were significantly associated with increased mortality at 1 month, 6 months, and 1 year. RCS analysis demonstrated a positive correlation between elevated LGI scores and mortality risk.
LGI is significantly associated with mortality in critically ill NTSAH patients, suggesting its potential as a prognostic biomarker for risk stratification. Further validation through prospective cohort studies is necessary to confirm these findings.
非创伤性蛛网膜下腔出血（NTSAH）主要由颅内动脉瘤破裂引起，因其高死亡率和高发病率，是一项重大的全球健康挑战。白细胞血糖指数（LGI）是一种反映氧化应激和炎症的生物标志物，与不良心血管结局相关。然而，其在重症NTSAH患者中的预后价值仍不确定。了解LGI与患者预后之间的关系对于改善NTSAH的临床管理至关重要。
我们从重症监护医学信息数据库-IV（MIMIC-IV，版本2.2）中识别出NTSAH患者。参与者根据其LGI评分分为四分位数。在多个时间点评估死亡率：重症监护病房住院期间、住院期间以及入院后1个月、6个月和12个月。使用多变量Cox比例风险回归分析LGI与死亡率之间的关联。采用限制立方样条（RCS）分析来描述LGI评分与死亡风险之间的关系，并确定临界值。通过亚组分析、交互检验和似然比检验证实了这些发现的稳健性。
共纳入750例患者，其中57%为女性。重症监护病房死亡率为17%，住院期间为20%，1个月时为21%，6个月时为27%，1年时为29%。多变量Cox回归分析显示，较高的LGI评分与1个月、6个月和1年时死亡率增加显著相关。RCS分析表明LGI评分升高与死亡风险呈正相关。
LGI与重症NTSAH患者的死亡率显著相关，表明其作为风险分层预后生物标志物的潜力。需要通过前瞻性队列研究进行进一步验证以证实这些发现。
