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

• DOI: 10.1007/s10072-019-04182-x
• Publication Date: 2019-12-11T12:46:43Z
• Authors: Yating Jian; Lili zhao; Heying Wang; Tao Li; Lei Zhang; Man Sun; Meijuan Dang; Ye Li; Yiheng Zhang; Jiao Liu; Hong Sun; Huqing Wang; Ru Zhang; Yi Jia; Hongxing Zhang; Guilian Zhang
• Keywords: Adult; Aged, 80 and over; Male; Mechanical Thrombolysis; Bilirubin; Middle Aged; Prognosis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Outcome Assessment, Health Care; Humans; Female; Intracranial Hemorrhages; Aged; Ischemic Stroke; Retrospective Studies

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).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.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.Elevated admission bilirubin is an independent predictor of HT and sICH in AIS patients treated with MT.