Associations Between Serum Liver Enzymes and the Rupture Status of Intracranial Aneurysms

Abstract

Background:

Identifying biomarkers associated with intracranial aneurysm (IA) rupture is critical for clinical management. We investigated the association between serum liver enzyme levels and IA rupture status.

Methods:

We conducted a case-control study including 531 patients with unruptured intracranial aneurysms and 397 patients with ruptured intracranial aneurysms. Propensity score matching (PSM) was performed based on 5 key variables, namely, age, sex, hypertension status, aneurysm location, and size, resulting in 232 matched pairs. Associations between serum liver enzyme levels and IA rupture status were evaluated using both unconditional and conditional logistic regression models. The incremental discriminatory value of liver enzymes beyond conventional clinical factors was assessed using the area under the receiver operating characteristic curve, net reclassification index, and integrated discrimination improvement.

Results:

We observed that elevated levels of aspartate aminotransferase (AST) and lactate dehydrogenase (LDH), as well as decreased levels of cholinesterase (CHE), were significantly associated with IA rupture status in both the unmatched and matched analyses. Among all the subjects, the multivariate‒adjusted odds ratios (95% confidence intervals) comparing the highest versus lowest quartiles were 4.63 (2.20–9.76; p trend<0.001) for AST, 7.28 (3.84–13.78; p trend<0.001) for LDH, and 0.37 (0.20–0.68; p trend<0.001) for CHE. Matched analyses yielded consistent results. The addition of these biomarkers to the conventional model significantly improved the discrimination and reclassification of rupture status.

Conclusion:

Elevated AST and LDH levels and reduced CHE levels were independently associated with IA rupture status, suggesting that liver‒derived enzymes are accessible biomarkers of IA instability.

Clinical Impact

High aspartate aminotransferase and lactate dehydrogenase levels, coupled with low cholinesterase levels, were associated with aneurysm rupture status. These findings suggest that these readily-available enzymes may serve as diagnostic adjuncts to raise clinical suspicion for aneurysmal subarachnoid hemorrhage in emergency settings where patients present with acute severe headache.