The following is a summary of “Direct bilirubin: A predictor of hematoma expansion after intracerebral hemorrhage,” published in the September 2023 issue of Emergency Medicine by Jia, et al.

Previous research has revealed the involvement of various biomarkers in processes related to coagulation, hemostasis dysfunction, brain vascular integrity impairment, and inflammation, all of which are associated with hematoma expansion (HE) after intracerebral hemorrhage (ICH). For a study, researchers sought to investigate whether there are yet undiscovered laboratory biomarkers readily available in clinical practice associated with HE.

The study involved a retrospective analysis of consecutive acute ICH patients from 2012 to 2020. These patients had admission laboratory tests and baseline and follow-up computed tomography (CT) scans. Univariate and multivariate regression analyses explored associations between conventional laboratory indicators and HE. The findings were further validated in a prospective cohort. The study also examined the relationship between the identified biomarker and 3-month outcomes, using mediation analysis to determine potential causal links among the biomarker, HE, and outcomes.

Among the 734 ICH patients studied, 163 (22.2%) experienced HE. Higher levels of direct bilirubin (DBil) were associated with the occurrence of HE, with an adjusted odds ratio (OR) of 1.082 for every 1.0 μmol/L increase (95% CI: 1.011–1.158). This relationship was validated, as DBil >5.65 μmol/L was found to predict HE in the validation cohort. Elevated DBil levels were also linked to poorer 3-month outcomes. Mediation analysis suggested that the association between higher DBil levels and adverse outcomes was partially mediated by HE.

Direct bilirubin (DBil) serves as a predictor for HE and poor 3-month outcomes following ICH. The involvement of DBil in the metabolic process and its role in the pathological mechanism of HE contribute to the association between DBil and HE. Interventions that target DBil to enhance post-ICH prognosis may hold significance and warrant further investigation.

Source: sciencedirect.com/science/article/pii/S0735675723003376