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By the 6-month follow-up, a total of 31 patients had died, and 50 patients had experienced a major disability (mRS score of 3-5). Table 1 shows the baseline characteristics among patients in the different GGT categories. Compared to the patients with lower GGT levels, subjects with higher GGT levels were more likely to be male, drinkers and to have more aneurysms in circle of willis and fewer aneurysms in anterior circulation. They also tended to have higher diastolic blood pressures, higher admission severity and larger aneurysm diameters.
Characteristics GGT < 30 U/L
18 (14-23)#30 U/L ≤ GGT < 50 U/L
37.5 (33-43) #GGT ≥ 50 U/L
71.5 (59.5-108.5) #P Value N 276 62 48 Age, (y) 57 ± 11.8 55.7 ± 10.8 53.6 ± 11 0.17 Male, n (%) 69 (25.0) 41 (66.1) 33 (68.8) < 0.01* Systolic blood pressure, (mmHg) 146 ± 23.9 153 ± 23.5 152 ± 28.1 0.07 Diastolic blood pressure, (mmHg) 86 ± 14.2 92 ± 17.3 91 ± 13.9 < 0.01* Blood glucose, (mmol/L) 7.9 ± 3.2 7.4 ± 2.2 8.4 ± 2.9 0.24 Aneurysm diameter, (mm) 5.4 ± 3.0 6.1 ± 2.9 7.1 ± 4.8 < 0.01* Drinking, n (%) 41 (14.9) 13 (21.0) 15 (31.3) 0.02* Hunt-Hess grade ≥ 3, n (%) 72 (26.1) 20 (32.3) 23 (47.9) 0.01* Fisher scale ≥ 3, n (%) 89 (32.3) 24 (38.7) 26 (54.2) 0.01* GCS ≤ 8, n (%) 33 (12.0) 8 (11.9) 13 (27.1) 0.02* Endovascular coiling, n (%) 232 (84.1) 52 (83.9) 39 (81.3) 0.89 Delayed cerebral ischemia 16 (5.8) 4 (6.5) 3 (6.3) 0.98 Interval from onset to admission#, (h) 8 (4-24) 8.5 (5-24) 10 (5-31) 0.79 Total bilirubin#, (μmol/L) 14.5 (11-18.5) 14.8 (11.4-20.3) 14.7 (10.5-19.5) 0.64 Location Anterior circulation, n (%) 198 (71.7) 38 (61.3) 23 (47.9) 0.003* Posterior circulation, n (%) 14 (5.1) 5 (8.1) 5 (10.4) 0.33 Circle of Willis, n (%) 64 (23.2) 19 (30.7) 20 (41.7) 0.02* Note. #was expressed by median (interquartile range); other continuous variables were expressed by mean ± standard deviation. *represented statistically significance (P < 0.05). Table 1. Baseline Characteristics of Participants According to Different GGT Levels
The graph in Figure 1 shows the relationship between functional recovery and each of the three GGT levels. The category with the lowest GGT had a median mRS score of 0 (interquartile range: 0-1), whereas the highest GGT category had a median mRS score of 1 (interquartile range: 0-5; P < 0.001). This figure reveals a stepwise, dose-dependent relationship between GGT levels and functional outcome (P < 0.01).
At the 6-month follow-up, the poor outcome rates after adjusting for age, sex and admission severity in the three groups, GGT < 30 U/L, 30 U/L ≤ GGT < 50 U/L and GGT ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively (P < 0.01) (Figure 2).
Figure 2. The adjusted poor outcome rates at the 6-month follow-up among the different GGT categories.
As shown in Table 2, among all patients, a per unit increase in GGT level was associated with a 1.03-fold increased risk of poor prognosis in the multivariable adjusted model (P < 0.05). Compared to the patients with GGT < 30 U/L, those with GGT ≥ 50 U/L had a higher risk of poor prognosis [OR (95% CI): 5.76 (2.74-12.13)] in the age-sex adjusted model. After further adjusting for blood pressure, fasting glucose, aneurysm diameter, aneurysm location, Hunt-Hess grade, Fisher scale, GCS, delayed cerebral ischemia, treatment and interval from onset to admission, this association was strengthened as the adjusted OR (95% CI) was 6.64 (2.05-21.52). After further adjustment for drinking status and total bilirubin, this association remained significant [OR (95% CI): 6.36 (1.92-21.02)]. A linear trend was observed in both the age-sex and multivariable adjusted models. This significant relationship between the level of GGT and aSAH prognosis was not substantially altered when we restricted the analysis to nondrinking patients.
GGT (U/L) Outcome Event/Total Number Model 1 Model 2 Model 3 Total patients Per unit increase 81/386 1.02 (1.01-1.03) 1.03 (1.01-1.04) 1.03 (1.01-1.04) < 30 46/276 1.00 (ref) 1.00 (ref) 1.00 (ref) 30-50 14/62 1.89 (0.90-3.93) 1.82 (0.59-5.67) 1.76 (0.57-5.51) ≥ 50 21/48 5.76 (2.74-12.13) 6.64 (2.05-21.52) 6.36 (1.92-21.02) P value for linear trend < 0.01 < 0.01 < 0.01 < 0.01 Nondrinking patients Per unit increase 67/317 1.02 (1.01-1.03) 1.02 (1.00-1.04) 1.02 (1.00-1.04) < 30 42/235 1.00 (ref) 1.00 (ref) 1.00 (ref) 30-50 11/49 1.55 (0.69-3.47) 1.44 (0.42-5.00) 1.44 (0.42-5.01) ≥ 50 14/33 4.94 (2.09-11.70) 5.56 (1.42-21.75) 5.55 (1.43-21.63) P value for linear trend < 0.01 < 0.01 0.02 0.02 Note. Model 1: adjusted for age and sex. Model 2: adjusted for model 1 plus blood pressure, blood glucose, aneurysm diameter, location, Hunt-Hess grade, Fisher scale, GCS, delayed cerebral ischemia, treatment and interval from onset to admission. Model 3: adjusted for model 2 plus total bilirubin and drinking status among total patients or adjusted for model 2 plus total bilirubin among nondrinking patients. Table 2. Adjusted Odds Ratios (95% CI) of Poor Outcome at 6-month Follow-up for Different GGT Levels