Bilirubin: a novel predictor of hemorrhagic transformation and symptomatic intracranial hemorrhage after mechanical thrombectomy

Background and purpose The role of bilirubin in patients treated with mechanical thrombectomy (MT) is unknown. We investigated the relationship between admission bilirubin levels and hemorrhagic complication in acute ischemic stroke (AIS) patients treated with MT and detailed the roles of direct bil...

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Published in:Neurological sciences 2020-04, Vol.41 (4), p.903-909
Main Authors: Jian, Yating, zhao, Lili, Wang, Heying, Li, Tao, Zhang, Lei, Sun, Man, Dang, Meijuan, Li, Ye, Zhang, Yiheng, Liu, Jiao, Sun, Hong, Wang, Huqing, Zhang, Ru, Jia, Yi, Zhang, Hongxing, Zhang, Guilian
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Bilirubin
Bilirubin - blood
Female
Hemorrhage
Humans
Intracranial Hemorrhages - blood
Intracranial Hemorrhages - diagnosis
Intracranial Hemorrhages - etiology
Ischemia
Ischemic Stroke - blood
Ischemic Stroke - complications
Ischemic Stroke - therapy
Male
Mechanical Thrombolysis - adverse effects
Medical imaging
Medicine
Medicine & Public Health
Middle Aged
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Original Article
Outcome Assessment, Health Care
Oxidative stress
Prognosis
Psychiatry
Regression analysis
Retrospective Studies
Roles
Statistical analysis
Stroke
Variables
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Summary:Background and purpose The role of bilirubin in patients treated with mechanical thrombectomy (MT) is unknown. We investigated the relationship between admission bilirubin levels and hemorrhagic complication in acute ischemic stroke (AIS) patients treated with MT and detailed the roles of direct bilirubin (DB), indirect bilirubin (IDB), and total bilirubin (TB). Methods Consecutive AIS patients treated with MT were enrolled from two stroke centers. Outcome measures included hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) within 48 h. An independent association of bilirubin with outcomes was identified by multivariate logistic regression analysis. The accuracies of bilirubin in predicting outcome were evaluated using receiver operating characteristic curve analysis. Results Of the 153 enrolled patients, 64 (41.8%) were diagnosed with HT, of which 28 (18.3%) had sICH. In univariate analyses, DB, IDB, and TB were higher in patients with HT and sICH than in patients without. After adjustment for potential confounders, DB (odds ratio [OR], 1.364; 95% confidence interval [CI], 1.133–1.641; p  = 0.001), IDB (OR, 1.143; 95% CI, 1.052–1.242; p  = 0.002), and TB (OR, 1.106; 95% CI, 1.041–1.175; p  = 0.001) were independently associated with HT. IDB (OR, 1.177; 95% CI, 1.064–1.303; p  = 0.002) and TB (OR, 1.102; 95% CI, 1.027–1.182; p  = 0.007) were independently associated with sICH. Receiver operating characteristic curve analysis showed no significant difference between the three indicators of predicting HT and sICH. Conclusions Elevated admission bilirubin is an independent predictor of HT and sICH in AIS patients treated with MT.
ISSN:1590-1874
1590-3478
DOI:10.1007/s10072-019-04182-x