Increased Serum Total Bile Acids can be Associated with a Small Hematoma Volume and Decreased Clinical Severity During Acute Intracerebral Hemorrhage

Background: The impact of Total Bile Acids (TBA) level on clinical outcomes after acute Intracerebral Hemorrhage (ICH) is still not understood. Objective: We investigated whether admission TBA level is associated with hematoma volume, stroke clinical severity, and 3-month outcomes in acute ICH patients. Methods: A total of 335 ICH patients were prospectively enrolled. Patients were divided into four groups, according to the quartiles of serum TBA level at the time of admission. Three-month outcomes were evaluated by interviews with patients or their family members. Results: The median hematoma volumes for the quartiles of TBA level (Q1 to Q4) were 12.0, 12.3, 10.0, and 6.7 mL (P<0.001) and the median National Institutes of Health Stroke Scale (NIHSS) scores were 8, 8, 6, and 5 (P=0.002), respectively. In the adjusted models, patients in the highest quartile (Q4) had smaller hematoma volumes (P=0.039) and lower NIHSS scores (P=0.037) than patients in Q1. At three months follow-up, there were 136 patients with poor outcomes (defined as having modified Rankin Scale scores≥3) and 46 cases of all-cause deaths. TBA level was not significantly associated with poor outcome nor all-cause death after adjusting for age, sex, hematoma volume, and baseline NIHSS(all P-trend≥0.380). Conclusions: Higher admission TBA was associated with smaller hematoma volume and decreased clinical severity, but not three month outcomes in patients with acute ICH.