Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-07-01T02:54:41.425Z Has data issue: false hasContentIssue false
  • English
  • Français

Association of Serum Bilirubin with Stroke Severity and Clinical Outcomes

Published online by Cambridge University Press:  23 September 2014

Tian Xu ,
Jintao Zhang ,
Tan Xu ,
Wenqing Liu ,
Yan Kong  and
Yonghong Zhang
Tian Xu
Affiliation:
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu Province
Jintao Zhang
Affiliation:
Department of Neurology, The 88th Hospital of PLA, Tai'an, Shandong Province, China
Tan Xu
Affiliation:
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu Province
Wenqing Liu
Affiliation:
Department of Neurology, The 88th Hospital of PLA, Tai'an, Shandong Province, China
Yan Kong
Affiliation:
Department of Neurology, The 88th Hospital of PLA, Tai'an, Shandong Province, China
Yonghong Zhang*
Affiliation:
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu Province
*
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, China, 215123. Email: yhzhang@suda.edu.cn
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The aim of the study is to explore the association of serum bilirubin levels with admission severity and short term clinical outcomes among acute ischemic stroke patients.

Methods:

Data were collected from 2361 acute ischemic stroke patients in four hospitals of Shangdong Province during January 2006 and December 2008. National Institutes of Health Stroke Scale (NIHSS) was used to assess admission and discharge severity. NIHSS≥10 at discharge or in-hospital death was defined as short-term clinical outcomes. Logistic regression and trend test were used to examine the association of serum bilirubin levels with admission severity and short term clinical outcomes.

Results:

Serum bilirubin levels were significantly and positively associated with admission severity (P for trend <0.05). The age-sex adjusted odds ratios (95% confidential intervals) of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.245 (0.873, 1.777)/1.276 (0.895, 1.818), 1.484 (1.048, 2.102)/1.628 (1.158, 2.289) and 2.869 (2.076, 3.966)/2.765 (1.996, 3.828), respectively, compared with the lowest quartile; the multivariate adjusted odds ratios of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.088(0.711, 1.665)/1.436(0.94, 2.193), 1.328(0.877, 2.011)/1.647(1.092, 2.485) and 2.336(1.579, 3.458)/3.079 (2.049, 4.623), respectively, compared with the lowest quartile. However, no association between serum bilirubin levels and short-term clinical outcomes was observed in our study.

Conclusion:

Serum bilirubin levels were associated with initial stroke severity closely. Nevertheless, there is no significant relationship between serum bilirubin levels and short-term clinical outcomes among acute ischemic stroke patients.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 1 , January 2013 , pp. 80 - 84
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. WHO. The top 10 causes of death. Geneva, Switzerland: World Health Organization. 2008.Google Scholar
2. Feigin, VL. Stroke epidemiology in the developing world. Lancet. 2005 Jun 25-Jul 1;365(9478):2160–1.Google Scholar
3. Heeley, E, Anderson, CS, Huang, Y, et al. Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke. 2009 Jun;40(6):2149–56.Google Scholar
4. Zhang, LF, Yang, J, Hong, Z, et al. Proportion of different subtypes of stroke in China. Stroke. 2003 Sep;34(9):2091–6.Google Scholar
5. Stocker, R, Yamamoto, Y, McDonagh, AF, Glazer, AN, Ames, BN. Bilirubin is an antioxidant of possible physiological importance. Science. 1987 Feb 27;235(4792):1043–6.Google Scholar
6. Vitek, L. Impact of serum bilirubin on human diseases. Pediatrics. 2005 May;115(5):1411–2.CrossRefGoogle ScholarPubMed
7. Oveson, BC, Iwase, T, Hackett, SF, et al. Constituents of bile, bilirubin and TUDCA, protect against oxidative stress-induced retinal degeneration. J Neurochem. 2011 Jan;116(1):144–53.Google Scholar
8. Liu, Y, Zhu, B, Wang, X, et al. Bilirubin as a potent antioxidant suppresses experimental autoimmune encephalomyelitis: implications for the role of oxidative stress in the development of multiple sclerosis. J Neuroimmunol. 2003 Jun;139(1-2):27–35.Google Scholar
9. Clark, JE, Foresti, R, Green, CJ, Motterlini, R. Dynamics of haem oxygenase-1 expression and bilirubin production in cellular protection against oxidative stress. Biochem J. 2000 Jun 15;348 Pt 3:615–9.Google Scholar
10. Giral, P, Ratziu, V, Couvert, P, et al. Plasma bilirubin and gamma-glutamyltransferase activity are inversely related in dyslipidemic patients with metabolic syndrome: relevance to oxidative stress. Atherosclerosis. 2010 Jun;210(2):607–13.Google Scholar
11. Perloff, D, Grim, C, Flack, J, et al. Human blood pressure determination by sphygmomanometry. Circulation. 1993 Nov;88(5 Pt 1):2460–70.Google Scholar
12. Bhutani, VK, Gourley, GR, Adler, S, Kreamer, B, Dalin, C, Johnson, LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000 Aug;106(2):E17.Google Scholar
13. Morozova, VT. [On a method of bilirubin determination (according to Jendrassik, Cleghorn and Grof)]. Lab Delo. 1965;10:588–91.Google Scholar
14. Sitzmann, FC, Eschler, P. [Enzymatic determination of blood glucose with a modified hexokinase method]. Med Klin. 1970 Jun 12;65(24):1178–83.Google Scholar
15. Allain, CC, Poon, LS, Chan, CS, Richmond, W, Fu, PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974 Apr;20(4):470–5.Google Scholar
16. Friedewald, WT, Levy, RI, Fredrickson, DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499–502.Google Scholar
17. Khatri, P, Hill, MD, Palesch, YY, et al. Methodology of the Interventional Management of Stroke III Trial. Int J Stroke. 2008 May;3(2):130–7.CrossRefGoogle ScholarPubMed
18. Pineda, S, Bang, OY, Saver, JL, et al. Association of serum bilirubin with ischemic stroke outcomes. J Stroke Cerebrovasc Dis. 2008 May-Jun;17(3):147–52.Google Scholar
19. Kurzepa, J, Bielewicz, J, Stelmasiak, Z, Bartosik-Psujek, H. Serum bilirubin and uric acid levels as the bad prognostic factors in the ischemic stroke. Int J Neurosci. 2009;119(12):2243–9.Google Scholar
20. Shiomi, S, Habu, D, Kuroki, T, Ishida, S, Tatsumi, N. Clinical usefulness of conjugated bilirubin levels in patients with acute liver diseases. J Gastroenterol. 1999 Feb;34(1):88–93.Google Scholar
21. Reinhartz, O, Farrar, DJ, Hershon, JH, Avery, GJ Jr., Haeusslein, EA, Hill, JD. Importance of preoperative liver function as a predictor of survival in patients supported with Thoratec ventricular assist devices as a bridge to transplantation. J Thorac Cardiovasc Surg. 1998 Oct;116(4):633–40.Google Scholar
22. Li, B, Wang, Z, Fang, JJ, Xu, CY, Chen, WX. Evaluation of prognostic markers in severe drug-induced liver disease. World J Gastroenterol. 2007 Jan 28;13(4):628–32.Google Scholar
23. Ozkul, A, Akyol, A, Yenisey, C, Arpaci, E, Kiylioglu, N, Tataroglu, C. Oxidative stress in acute ischemic stroke. J Clin Neurosci. 2007 Nov;14(11):1062–6.Google Scholar
24. El Kossi, MM, Zakhary, MM. Oxidative stress in the context of acute cerebrovascular stroke. Stroke. 2000 Aug;31(8):1889–92.Google Scholar
25. Dohi, K, Satoh, K, Ohtaki, H, et al. Elevated plasma levels of bilirubin in patients with neurotrauma reflect its pathophysiological role in free radical scavenging. In Vivo. 2005 Sep-Oct;19(5):855–60.Google Scholar
26. Dohi, K, Mochizuki, Y, Satoh, K, et al. Transient elevation of serum bilirubin (a heme oxygenase-1 metabolite) level in hemorrhagic stroke: bilirubin is a marker of oxidant stress. Acta Neurochir Suppl. 2003;86:247–9.Google Scholar
27. Perlstein, TS, Pande, RL, Creager, MA, Weuve, J, Beckman, JA. Serum total bilirubin level, prevalent stroke, and stroke outcomes: NHANES 1999-2004. Am J Med. 2008 Sep;121(9):781–8 e1.Google Scholar
28. Adams, HP Jr., Davis, PH, Leira, EC, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999 Jul 13;53(1):126–31.Google Scholar