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Mahadevan A, Krishnakumar M, Pinnamaneni M, Desai R. Serum direct bilirubin as a prognostic marker for short-term ischemic stroke morbidity and mortality: Pooled analysis of cohort studies. J Neurol Sci 2024; 463:123120. [PMID: 38996668 DOI: 10.1016/j.jns.2024.123120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/12/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES Recent research on serum bilirubin's impact on stroke outcomes presents conflicting evidence. Higher bilirubin levels have been associated with both protective effects against ischemic stroke and increased risk of poor neurological recovery and higher mortality. MATERIALS AND METHODS Systematic searching of the PubMed and SCOPUS databases from inception till April 2024 yielded 139 studies of which four were included for analysis. Adhering to MOOSE guidelines, we specifically assessed the association between high versus low direct bilirubin (DBIL) levels and poor neurological recovery using a narrowly defined criterion of the Modified Rankin Scale (mRS) score from 2 to 6. RESULTS The pooled analysis from four studies analyzed data, encompassed 12,632 acute ischemic stroke hospitalizations, indicates a significant association between high serum DBIL and increased risk of poor neurological recovery (OR: 1.89, 95% CI: [1.28-2.77], p < 0.01), with moderate study heterogeneity (I2 = 58%, p = 0.07). Publication bias was mild, with an LFK index of - 1.81. CONCLUSION Our findings suggest a potential association between elevated DBIL and a higher risk of post-stroke morbidity and mortality, indicating the need for further research to explore DBIL as a potential predictor of post-stroke neurological recovery and to understand its role in ischemic stroke pathophysiology better.
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Affiliation(s)
- Arankesh Mahadevan
- Department of Neurology, University of Utah Health, Salt Lake City, UT, USA,.
| | - Manaswini Krishnakumar
- Department of Internal Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, India
| | - Monitha Pinnamaneni
- Department of Internal Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, India
| | - Rupak Desai
- Independent Outcomes Researcher, Augusta, GA, USA
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Peng Q, Zeng W. The protective role of endothelial GLUT1 in ischemic stroke. Brain Behav 2024; 14:e3536. [PMID: 38747733 PMCID: PMC11095318 DOI: 10.1002/brb3.3536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To provide thorough insight on the protective role of endothelial glucose transporter 1 (GLUT1) in ischemic stroke. METHODS We comprehensively review the role of endothelial GLUT1 in ischemic stroke by narrating the findings concerning biological characteristics of GLUT1 in brain in depth, summarizing the changes of endothelial GLUT1 expression and activity during ischemic stroke, discussing how GLUT1 achieves its neuroprotective effect via maintaining endothelial function, and identifying some outstanding blind spots in current studies. RESULTS Endothelial GLUT1 maintains persistent high glucose and energy requirements of the brain by transporting glucose through the blood-brain barrier, which preserves endothelial function and is beneficial to stroke prognosis. CONCLUSION This review underscores the potential involvement of GLUT1 trafficking, activity modulation, and degradation, and we look forward to more clinical and animal studies to illuminate these mechanisms.
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Affiliation(s)
- Qiwei Peng
- Department of Critical Care Medicine, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology)Ministry of EducationWuhanChina
| | - Weiqi Zeng
- Department of NeurologyThe First People's Hospital of FoshanFoshanChina
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Sun M, Weng Y, Cheng J, Li G, Xiao Q. Higher baseline serum bilirubin levels are associated with increased risk of early neurological deterioration in women with acute ischemic stroke. Front Neurol 2024; 15:1381055. [PMID: 38651104 PMCID: PMC11033363 DOI: 10.3389/fneur.2024.1381055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Background and objectives Early neurological deterioration (END) occurs in up to one-third of patients with acute ischemic stroke (AIS) and associated with poor outcome. The role of serum bilirubin in END remains controversial. This study aims to investigate the association of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) with END. Methods This study was a cross-sectional retrospective study with 344 AIS patients enrolled. We retrospectively reviewed consecutive AIS patients with END through a medical record retrieval system and enrolled patients as control randomly from the AIS patients without END at the same period. The bilirubin levels were compared between the END group and No END group. The correlations of bilirubin with END were assessed according to the bilirubin tertiles on the cohort of different genders. Results In women, as the bilirubin level increased, the occurrence of END showed an increasing trend. The linear association was significant based on the tertiles of all bilirubin types (TBIL p = 0.003; DBIL p = 0.025; IBIL p = 0.025), while in men no similar trend was observed. After adjustment for confounders, higher TBIL (p for trend 0.009) and DBIL (p for trend 0.033) levels were associated with increased risk of END in women. The adjusted OR for T3 relative to T1 was 5.240 (95% CI 1.496-18.347) in TBIL and 3.549 (95% CI 1.089-11.566) in DBIL. Multivariate logistic regression showed that DBIL was independently associated with END in women (OR 1.717, 95% CI 1.106-2.666). The study also found that DBIL was superior to TBIL and IBIL in prediction of END occurrence in women, with greater predictive value. Discussion There were gender differences in the relationship between bilirubin and END, and DBIL level was positively associated with END occurrence in women, not in men. DBIL had greater incremental predictive value for END than TBIL and IBIL.
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Affiliation(s)
| | | | | | - Guoyi Li
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Xiao
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Jin H, Peng Q, Li M, Sun S, Zhou J, Hu J, Huang M, Chen X, Li Y, Zhou Y, Wan Y, Hong C, Chen S, Hu B. Supra-Blan 2 t score as a multisystem-based risk score to predict poor 3-month outcome in acute ischemic stroke patients with intravenous thrombolysis. CNS Neurosci Ther 2024; 30:e14381. [PMID: 37519114 PMCID: PMC10848105 DOI: 10.1111/cns.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
AIM To develop and validate a novel weighted score integrating multisystem laboratory and clinical variables to predict poor 3-month outcome (mRS score of 3-6) in acute ischemic stroke (AIS) patients with intravenous thrombolysis (IVT) therapy. METHODS We retrospectively analyzed data from Trial of Revascularization Treatment for Acute Ischemic Stroke study. The Supra-Blan2 t score was derived using the data on age, the National Institutes of Health Stroke Scale score, history of atrial fibrillation, blood sugar level, neutrophil count, direct bilirubin level, platelet-lymphocyte ratio, and TnI level in the derivation cohort of 433 patients, and validated in a cohort of 525 patients. Furthermore, we compared the performance of the Supra-Blan2 t score with DRAGON, TURN, and SPAN-100 scores. RESULTS The discrimination capacity in the derivation and validation cohorts was good for poor 3-month outcome (the area under the curve was 0.821 and 0.843, respectively). The cumulative incidence of poor 3-month outcome significantly increased across risk categories in the derivation (low-risk, 9.2%; medium-risk, 17.4%; and high-risk, 58.8%) and validation cohorts (12.7%, 36.5%, and 73.6%, respectively). The performance of the Supra-Blan2 t score was similar to or superior to DRAGON, TURN, and SPAN-100 scores. CONCLUSION The Supra-Blan2 t score, based on easily available multisystem laboratory and clinical variables, reliably predicted poor 3-month functional outcome in AIS patients treated with IVT therapy featuring good calibration and discrimination.
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Affiliation(s)
- Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Qiwei Peng
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Min Li
- Department of NeurologyThe Second People's Hospital of China Three Gorges UniversityYichangChina
| | - Shuai Sun
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jinghua Zhou
- Department of NeurologyThe First Clinical Medical College of China Three Gorges UniversityYichangChina
| | - Jichuan Hu
- Department of NeurologyPeople's Hospital of Dongxihu DistrictWuhanChina
| | - Ming Huang
- Department of NeurologyHubei Provincial Hospital of Integrated Chinese and Western MedicineWuhanChina
| | - Xinglong Chen
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yanan Li
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yifan Zhou
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Candong Hong
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Sun C, Ruan Z, Zhang Y, Guo R, Li H, Wang T, Gao T, Tang Y, Song N, Hao S, Huang X, Li S, Ning F, Su Y, Lu Q, Wang Q, Cao X, Li Z, Chang T. High indirect bilirubin levels as an independent predictor of postoperative myasthenic crisis: a single-center, retrospective study. Front Neurol 2024; 14:1336823. [PMID: 38283685 PMCID: PMC10811789 DOI: 10.3389/fneur.2023.1336823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Background Thymectomy is an efficient and standard treatment strategy for patients with myasthenia gravis (MG), postoperative myasthenic crisis (POMC) is the major complication related to thymectomy and has a strongly life-threatening effect. As a biomarker, whether the bilirubin level is a risk factor for MG progression remains unclear. This study aimed to investigate the association between the preoperative bilirubin level and postoperative myasthenic crisis (POMC). Methods We analyzed 375 patients with MG who underwent thymectomy at Tangdu Hospital between January 2012 and September 2021. The primary outcome measurement was POMC. The association between POMC and bilirubin level was analyzed by restricted cubic spline (RCS). Indirect bilirubin (IBIL) was divided into two subgroups based on the normal upper limit of IBIL, 14 μmol/L. Results Compared with non-POMC group, IBIL levels were significantly higher in patients with POMC. Elevated IBIL levels were closely associated with an increased risk of POMC (p for trend = 0.002). There was a dose-response curve relationship between IBIL levels and POMC incidence (p for non-linearity = 0.93). However, DBIL levels showed a U-shaped association with POMC incidence. High IBIL level (≥14 μmol/L) was an independent predictive factor for POMC [odds ratio = 3.47, 95% confidence interval (CI): 1.56-7.8, p = 0.002]. The addition of high IBIL levels improved the prediction model performance (net reclassification index = 0.186, 95% CI: 0.039-0.334; integrated discrimination improvement = 0.0345, 95% CI: 0.005-0.065). Conclusion High preoperative IBIL levels, especially those exceeding the normal upper limit, could independently predict the incidence of POMC.
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Affiliation(s)
- Chao Sun
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yu Zhang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Rongjing Guo
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Huanhuan Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tantan Wang
- School of Pharmaceutical Sciences, Peking-Tsinghua Center for Life Sciences, Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology (Ministry of Education), Tsinghua University, Beijing, China
| | - Ting Gao
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yonglan Tang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Na Song
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Sijia Hao
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoxi Huang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shuang Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Ning
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yue Su
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qiang Lu
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qingqing Wang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiangqi Cao
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
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Jia Y, Ye X, Song G, Li X, Ye J, Yang Y, Lu K, Huang S, Zhu S. Direct bilirubin: A predictor of hematoma expansion after intracerebral hemorrhage. Am J Emerg Med 2023; 71:150-156. [PMID: 37393774 DOI: 10.1016/j.ajem.2023.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Previous evidence demonstrated that several biomarkers involved in the pathological process of coagulation/hemostasis dysfunction, impairment of brain vascular integrity and inflammation are associated with hematoma expansion (HE) after intracerebral hemorrhage (ICH). We aimed to explore whether there were unreported laboratory biomarkers associated with HE that were readily and commonly available in clinical practice. METHODS We retrospectively analyzed consecutive acute ICH patients from 2012 to 2020 with admission laboratory tests and baseline and follow-up computed tomography (CT) scans. Univariate and multivariate regression analyses were used to evaluate associations between conventional laboratory indicators and HE. The results were verified in a prospective validation cohort. The relationship of candidate biomarker and 3-month outcomes was also investigated and mediation analysis was undertaken to determine causal associations among candidate biomarker, HE and outcome. RESULTS Of 734 ICH patients, 163 (22.2%) presented HE. Among the included laboratory indicators, higher direct bilirubin (DBil) was associated with HE (adjusted odds ratio [OR] of per 1.0 μmol/L change 1.082; 95% confidence interval [CI] 1.011-1.158). DBil >5.65 μmol/L was a predictor of HE in validation cohort. Higher DBil was also associated with poor 3-month outcomes. The mediation analysis indicated that the association of higher DBil and poor outcomes was partially mediated by HE. CONCLUSIONS DBil is a predictor of HE and poor 3-month outcomes after ICH. DBil's metabolic process and involvement in the pathological mechanism of HE are likely to contribute to the association between DBil and HE. Interventions targeting DBil to improve post-ICH prognosis may be meaningful and worthy of further exploration.
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Affiliation(s)
- Yuchao Jia
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xiaodong Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Guini Song
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xianxian Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jiahe Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yuyan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Kai Lu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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Duan H, Geng X, Ding Y. Hepatic responses following acute ischemic stroke: A clinical research update. Brain Circ 2023; 9:57-60. [PMID: 37576577 PMCID: PMC10419733 DOI: 10.4103/bc.bc_31_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 08/15/2023] Open
Abstract
Acute ischemic stroke (AIS) not only affects the brain but also has significant implications for peripheral organs through neuroendocrine regulation. This reciprocal relationship influences overall brain function and stroke prognosis. Recent research has highlighted the importance of poststroke liver changes in determining patient outcomes. In our previous study, we investigated the relationship between stroke and liver function. Our findings revealed that the prognostic impact of stress-induced hyperglycemia in patients undergoing acute endovascular treatment for acute large vessel occlusion is closely related to their preexisting diabetes status. We found that the liver contributes to stress hyperglycemia after AIS by increasing hepatic gluconeogenesis and decreasing hepatic insulin sensitivity. These changes are detrimental to the brain, particularly in patients without diabetes. Furthermore, we examined the role of bilirubin, a byproduct of hepatic hemoglobin metabolism, in stroke pathophysiology. Our results demonstrated that blood bilirubin levels can serve as predictors of stroke severity and may hold therapeutic potential for reducing oxidative stress-induced stroke injury in patients with mild stroke. These results underscore the potential role of the liver in the oxidative stress response following AIS, paving the way for further investigation into liver-targeted therapeutic strategies to improve stroke prognosis and patient outcomes.
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Affiliation(s)
- Honglian Duan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Yuchuan Ding
- Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, USA
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Zhao K, Wang R, Chen R, Liu J, Ye Q, Wang K, Li J. Association between bilirubin levels with incidence and prognosis of stroke: A meta-analysis. Front Neurosci 2023; 17:1122235. [PMID: 36866331 PMCID: PMC9971723 DOI: 10.3389/fnins.2023.1122235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Objective Bilirubin has anti-inflammatory, antioxidant, and neuroprotective properties, but the association between bilirubin and stroke remains contentious. A meta-analysis of extensive observational studies on the relationship was conducted. Methods Studies published before August 2022 were searched in PubMed, EMBASE, and Cochrane Library. Cohort, cross-sectional and case-control studies that examined the association between circulating bilirubin and stroke were included. The primary outcome included the incidence of stroke and bilirubin quantitative expression level between stroke and control, and the secondary outcome was stroke severity. All pooled outcome measures were determined using random-effects models. The meta-analysis, subgroup analysis, and sensitivity analysis were performed using Stata 17. Results A total of 17 studies were included. Patients with stroke had a lower total bilirubin level (mean difference = -1.33 μmol/L, 95% CI: -2.12 to -0.53, P < 0.001). Compared with the lowest bilirubin level, total odds ratio (OR) of the highest bilirubin for the occurrence of stroke was 0.71 (95% CI: 0.61-0.82) and ischemic stroke was 0.72 (95% CI: 0.57-0.91), especially in cohort studies with accepted heterogeneity (I 2 = 0). Serum total and direct bilirubin levels were significantly and positively associated with stroke severity. A stratified analysis based on gender showed that the total bilirubin level in males correlated with ischemic stroke or stroke, which was not noted in females. Conclusion While our findings suggest associations between bilirubin levels and stroke risk, existing evidence is insufficient to establish a definitive association. Better-designed prospective cohort studies should further clarify pertinent questions (PROSPERO registration number: CRD42022374893).
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Affiliation(s)
- Kun Zhao
- Department of Rehabilitation Medicine, Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Rui Wang
- Department of Rehabilitation Medicine, Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Rongrong Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jialei Liu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qing Ye
- Department of Rehabilitation Medicine, Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kai Wang
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Juebao Li
- Department of Rehabilitation Medicine, Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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9
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Chen X, Yang X, Xu X, Fu F, Huang X. Higher serum bilirubin levels are associated with hemorrhagic transformation after intravenous thrombolysis in acute ischemic Stroke. Front Aging Neurosci 2023; 15:1159102. [PMID: 37143690 PMCID: PMC10151741 DOI: 10.3389/fnagi.2023.1159102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
Background Bilirubin has both antioxidative and prooxidative properties. The study aimed to explore the relationship between serum bilirubin and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke. Methods The patients receiving intravenous thrombolysis with alteplase were retrospectively analyzed. HT was defined as new intracerebral hemorrhage in follow-up computed tomography images within 24-36 h after thrombolysis. Symptomatic intracranial hemorrhage (sICH) was defined as HT accompanied by worsening neurological function. Multivariate logistic regression and spline regression models were performed to investigate the relationship between serum bilirubin levels and the risk of HT and sICH. Results Among 557 included patients, 71 (12.7%) were diagnosed with HT and 28 (5.0%) developed sICH. Patients with HT had significant higher baseline serum total bilirubin, direct bilirubin, and indirect bilirubin levels than those without HT. Multivariable logistic regression analysis indicated that patients with higher serum bilirubin levels, including total bilirubin (OR 1.05, 95% CI 1.01-1.08, p = 0.006), direct bilirubin (OR 1.18, 95% CI 1.05-1.31, p = 0.004), and indirect bilirubin (OR 1.06, 95% CI 1.02-1.10, p = 0.005) had increased risk of HT. Furthermore, multiple-adjusted spline regression models excluded nonlinear association between serum bilirubin levels and HT (p > 0.05 for nonlinearity). Similar results were present between serum bilirubin and sICH. Conclusion The data showed the positively linearly relationship between serum bilirubin levels and the risk of HT and sICH in patients with acute ischemic stroke undergoing intravenous thrombolysis.
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Affiliation(s)
- Xiaoqing Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangchou Yang
- Department of Hematology and Medical Oncology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia Xu
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - FangWang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- FangWang Fu,
| | - Xiangwei Huang
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Xiangwei Huang,
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10
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Xu Q, Hu L, Chen L, Li H, Tian X, Zuo Y, Zhang Y, Zhang X, Sun P, Wang Y, Meng X, Wang A. Low serum magnesium is associated with poor functional outcome in acute ischemic stroke or transient ischemic attack patients. CNS Neurosci Ther 2022; 29:842-854. [PMID: 36415111 PMCID: PMC9928556 DOI: 10.1111/cns.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/12/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022] Open
Abstract
AIM The association between magnesium and outcomes after stroke is uncertain. We aimed to investigate the association of serum magnesium with all-cause mortality and poor functional outcome. METHODS We included patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) from the China National Stroke Registry III. We used Cox proportional hazards model for all-cause mortality and logistic regression model for poor functional outcome (modified Rankin Scale [mRS] 2-6/3-6) to examine the relationships. RESULTS Among the 6483 patients, the median (interquartile range) magnesium was 0.87 (0.80-0.93) mmol/L. Patients in the first quartile had a higher risk of mRS score 3-6/2-6 at 3 months (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.02, 1.64; adjusted OR: 1.29; 95% CI: 1.04-1.59) compared with those in the fourth quartile. Similar results were found for mRS score 26 at 1 year. The age- and sex-adjusted hazard ratio (HR) with 95% CI in first quartile magnesium was 1.40 (1.02-1.93) for all-cause mortality within 1 year, but became insignificant (HR: 1.03; 95% CI: 0.71-1.50) after adjusting for potential variables. CONCLUSIONS Low serum magnesium was associated with a high risk of poor functional outcome in patients with AIS or TIA.
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Affiliation(s)
- Qin Xu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Lele Hu
- The Second People's Hospital of GuiyangGuizhouChina
| | - Lu Chen
- Department of NeurologyZiBo Central HospitalZiboChina
| | - Hao Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xue Tian
- Department of Epidemiology and Health StatisticsSchool of Public Health, Capital Medical UniversityBeijingChina,Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yingting Zuo
- Department of Epidemiology and Health StatisticsSchool of Public Health, Capital Medical UniversityBeijingChina,Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Ping Sun
- The Second People's Hospital of GuiyangGuizhouChina
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina,Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina,Center for Excellence in Brain Science and Intelligence TechnologyChinese Academy of SciencesShanghaiChina
| | - Xia Meng
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
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Liu F, Chen C, Bai Z, Hong W, Wang S, Tang C. Specific subsystems of the inferior parietal lobule are associated with hand dysfunction following stroke: A cross-sectional resting-state fMRI study. CNS Neurosci Ther 2022; 28:2116-2128. [PMID: 35996952 PMCID: PMC9627383 DOI: 10.1111/cns.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
AIM The inferior parietal lobule (IPL) plays important roles in reaching and grasping during hand movements, but how reorganizations of IPL subsystems underlie the paretic hand remains unclear. We aimed to explore whether specific IPL subsystems were disrupted and associated with hand performance after chronic stroke. METHODS In this cross-sectional study, we recruited 65 patients who had chronic subcortical strokes and 40 healthy controls from China. Each participant underwent the Fugl-Meyer Assessment of Hand and Wrist and resting-state fMRI at baseline. We mainly explored the group differences in resting-state effective connectivity (EC) patterns for six IPL subregions in each hemisphere, and we correlated these EC patterns with paretic hand performance across the whole stroke group and stroke subgroups. Moreover, we used receiver operating characteristic curve analysis to distinguish the stroke subgroups with partially (PPH) and completely (CPH) paretic hands. RESULTS Stroke patients exhibited abnormal EC patterns with ipsilesional PFt and bilateral PGa, and five sensorimotor-parietal/two parietal-temporal subsystems were positively or negatively correlated with hand performance. Compared with CPH patients, PPH patients exhibited abnormal EC patterns with the contralesional PFop. The PPH patients had one motor-parietal subsystem, while the CPH patients had one sensorimotor-parietal and three parietal-occipital subsystems that were associated with hand performance. Notably, the EC strength from the contralesional PFop to the ipsilesional superior frontal gyrus could distinguish patients with PPH from patients with CPH. CONCLUSIONS The IPL subsystems manifest specific functional reorganization and are associated with hand dysfunction following chronic stroke.
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Affiliation(s)
- FeiWen Liu
- Department of Rehabilitation MedicineChengdu Second People's HospitalChengduChina
| | - ChangCheng Chen
- Department of Rehabilitation MedicineQingtian People's HospitalLishuiChina
| | - ZhongFei Bai
- Yangzhi Rehabilitation Hospital Affiliated to Tongji University (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - WenJun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - SiZhong Wang
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of PhysiotherapyUniversity of OtagoDunedinNew Zealand
| | - ChaoZheng Tang
- Capacity Building and Continuing Education CenterNational Health Commission of the People's Republic of ChinaBeijingChina
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