Incremental prognostic value of multidomain baseline laboratory biomarkers beyond neurological and radiographic grading in ICU patients with aneurysmal subarachnoid hemorrhage

Background Early prognostic assessment in ICU patients with aneurysmal subarachnoid hemorrhage (aSAH) is clinically critical. Traditional neurological and radiographic grading systems, such as the Glasgow Coma Scale (GCS), modified Fisher grade (mFG), intraventricular hemorrhage (IVH), 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 traditional neurological and radiographic grading. Methods In this retrospective single-center study, 1,164 ICU patients with aSAH were included. Baseline laboratory biomarkers ( n = 214) obtained at hospital admission 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 discharge functional outcome (mRS 3–6) as the dependent variable. Results Baseline GCS discriminated discharge functional outcome in severe aSAH but not in mild aSAH. 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, gender, GCS, mFG, and IVH showed limited specificity, particularly in mild aSAH (AUC = 0.640). Addition of baseline laboratory biomarkers markedly improved predictive performance (AUC = 0.737 in mild aSAH; AUC = 0.877 in severe aSAH). Conclusions Multidomain baseline laboratory biomarkers provide substantial incremental predictive value for discharge functional outcomes beyond traditional neurological and radiographic grading scales in ICU patients with aSAH, particularly in mild cases.