To explore the correlation between total bilirubin (TBil) and neurological function recovery in patients with intracerebral hemorrhage (ICH) after decompressive craniectomy (DC).

A total of 120 patients with ICH who underwent DC in Neurosurgery Department of Nanjing Luhe People's Hospital from January 2020 to January 2024 were selected as the research subjects. The patients were divided into a good recovery group (n=74) and a poor recovery group (n=46) according to the effect of nerve function recovery. The clinical data, serological indicators, vascular endothelial function indicators and TBil of two groups of patients were compared. The time effect, intergroup effect and interaction effect of vascular endothelial function indicators and TBil were analyzed by repeated measurement of variance. The multivariate Logistic was used to analyze the factors of poor recovery of neurological function. The locally weighted regression (Lowess) was used to analyze the correlation between TBil level and vascular endothelial function indicators. The restricted cubic spline (RCS) model was established to analyze the dose-response relationship between TBil and poor recovery of neurological function in patients with ICH. The Bootstrap method was used to examine the mediating effect of TBil level on vascular endothelial function and poor recovery of neurological function.

The age, GCS score, smoking, diabetes, hypertension, preoperative blood loss, length of ICU stay, apolipoprotein B (ApoB), apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) and C-reactive protein (CRP) in the two groups were statistically significant (P<0.05); and the levels of nitric oxide (NO), endothelin-1 (ET-1), calcitonin gene related peptide (CGRP), vascular endothelial growth factor (VEGF), TBil and activity of daily living (ADL) score in the two groups before surgery and at 7 and 14 d after surgery were statistically significant (P<0.05). The repeated measurement of variance showed that the time effect, intergroup effect and interaction effect of NO, ET-1, CGRP, VEGF and TBil in the two groups were statistically significant (P<0.05). The multivariate Logistic analysis showed that smoking, diabetes, hypertension, age (>50 years), GCS score (≤9 scores), preoperative blood loss (>44.8 mL), length of ICU stay (>8 d), ADL score (≤65 scores), ApoB (>1.37 g/L), ApoB/ApoA1 (>0.99), CRP (>12.30 mg/L), NO (≤12.35 μmol/L), ET-1 (>47.30 ng/L), CGRP (≤52.05 ng/L), VEGF (>233.85 μg/L) and TBil (>13.64 μmol/L) were risk factors for poor neurological recovery in patients with ICH (P<0.05). The Lowess analysis showed that TBil was negatively correlated with NO and CGRP, and positively correlated with ET-1 and VEGF, and all the correlations were statistically significant (P<0.05). The RCS model analysis showed that TBil was correlated with the risk of poor postoperative neurological function recovery in a nonlinear dose-response relationship (P _{for non linear}<0.05). The mediation effect model showed that TBil played a partial mediating effect between NO, ET-1, CGRP, VEGF and poor neurological function recovery.

After DC, there is a significant linear correlation between TBil and function recovery index in patients with ICH. TBil (>13.64 μmol/L) is an independent risk factor for poor neurological recovery, and the lower the postoperative TBil level, the better the neurological function recovery effect.