Incremental Prognostic Value of Multidomain Baseline Laboratory Biomarkers Beyond Neurological Grading in ICU Patients With Aneurysmal Subarachnoid Hemorrhage

Background : Early prognostic assessment in ICU patients with aneurysmal spontaneous subarachnoid hemorrhage (SAH) is clinically critical. Traditional neurological grading systems, such as the Glasgow Coma Scale (GCS) and Hunt–Hess (HH) scale, may not fully capture systemic physiological derangements that influence outcomes. We investigated whether integration of baseline laboratory biomarkers improves prognostic prediction beyond age and GCS. Methods : In this retrospective single-center study, 1,164 ICU patients with aneurysmal spontaneous SAH were included. Baseline laboratory biomarkers (n=214) obtained within 24 hours prior to surgery were categorized into 12 physiological domains. Patients were stratified into mild (HH 1–2) and severe (HH 3–5) groups. Functional outcome at hospital discharge was assessed using the modified Rankin Scale (mRS). Multivariable logistic regression models were developed using training (70%) and validation (30%) datasets, with poor prognosis (mRS 3–6) as the dependent variable. Results : Baseline GCS discriminated prognosis in severe SAH but not in mild SAH. Poor outcomes were associated with higher inflammatory markers, stress-related metabolic indices, tissue injury biomarkers, and markers of organ dysfunction, whereas favorable outcomes reflected preserved physiological homeostasis. Models incorporating only age and GCS showed limited specificity, particularly in mild SAH (AUC=0.536). Addition of baseline laboratory biomarkers markedly improved predictive performance (AUC=0.751 in mild SAH; AUC=0.883 in severe SAH). Conclusions : Multidomain baseline laboratory biomarkers provide substantial incremental prognostic value beyond traditional neurological grading in ICU patients with aneurysmal SAH, particularly in mild cases.