PROGNOSTIC SIGNIFICANCE OF SERUM BILIRUBIN IN STROKE

Authors

  • Arsalan Arsalan
  • Muhammad Ismail
  • Muhammad Bilal Khattak
  • Faramoz Khan
  • Muhammad Jalil Anwar
  • Zeeshan Murtaza
  • Abuzar Khan

Abstract

Background: Oxidative injury is an important cause of the neurologic lesion in stroke. Serum bilirubinis considered a natural antioxidant that may affect the prognosis of stroke. The purpose of this studywas to evaluate the prognostic significance of bilirubin in stroke patients. Methods: A prospectivecross-sectional study was conducted in Medical Units of Khyber Teaching Hospital, Peshawar.Inpatients admitted with acute attack of stroke were included in this study. Data regarding serumbilirubin and concurrent cerebrovascular risk factors were collected. National Institutes of HealthStroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to analyse stroke’s severity andfunctional outcomes, respectively. Results: Hypertension, diabetes mellitus and heart diseases were themost common risk factors. Patients were divided into 3 groups on the basis of serum bilirubin, i.e., ≤0.6mg/dl (Group-1), 0.7–0.9 mg/dl (Group-2), and ≥1.0 mg/dl (Group-3). The mean pre-hospitalisationNIHSS score for Groups 1, 2 and 3 was 5.62, 11.66 and 25.33, respectively; and post-hospitalisationscore was 0.875, 3.76 and 16.26, respectively. The pre-hospitalisation mRS score was 4 for Group-1,4.52 for Group-2 and 4.93 for Group-3; while post-hospitalisation Mrs Score was 1.50, 2.38 and 4.26,respectively. Average serum bilirubin level was significantly higher in patients with poor outcomes ascompared with good outcomes (p<0.01). Conclusions: This study suggests that higher serum bilirubinlevels were associated with increased stroke severity, longer hospitalisation and poor prognosis.Keywords: Stroke severity, stroke outcome, stroke prognosis, serum bilirubin, National Institutes ofHealth Stroke Scale (NIHSS), modified Rankin Scale (mRS)

References

Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie

K, et al. Guidelines for prevention of stroke in patients with

ischemic stroke or transient ischemic attack: a statement for

healthcare professionals from the American Heart

Association/American Stroke Association Council on Stroke: cosponsored by the Council on Cardiovascular Radiology and

Intervention: the American Academy of Neurology affirms the

value of this guideline. Circulation 2006;113(10):e409–49.

Feigin VL. Stroke epidemiology in the developing world. Lancet

;365:2160–1.

Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet

;371:1612–23.

Khealani BA, Hameed B, Mapari UU. Stroke in Pakistan. J Pak

Med Assoc 2008;58:4003.

Jafar TH. Blood pressure, diabetes, and increased dietary salt

associated with stroke--results from a community-based study in

Pakistan. J Hum Hypertens 2006;20(1):83-5.

J Ayub Med Coll Abbottabad 2011;23(2)

http://www.ayubmed.edu.pk/JAMC/23-2/Arsalan.pdf 107

Ollinger R, Bilban M, Erat A, Froio A, McDaid J, Tyagi S, et al.

Bilirubin: a natural inhibitor of vascular smooth muscle cell

proliferation. Circulation 2005;112:1030–9.

Arsalan H, Ismail M, Anwar MJ, Murtaza Z, Khan F.

Relationship of serum albumin with the severity and outcomes of

stroke. Archives of Pharmacy Practice 2011;2(4):158–62.

Shekeeb Shahab M, Kumar P, Sharma N, Narang A, Prasad R.

Evaluation of oxidant and antioxidant status in term neonates: a

plausible protective role of bilirubin. Molecular and cellular

biochemistry 2008;317(1–2):51–9.

Sedlak TW, Saleh M, Higginson DS, Paul BD, Juluri KR, Snyder

SH. Bilirubin and glutathione have complementary antioxidant

and cytoprotective roles. Proc Natl Acad Sci USA

;106:5171–6.

Sarady-Andrews JK, Liu F, Gallo D, Nakao A, Overhaus M,

Ollinger R, et al. Biliverdin administration protects against

endotoxin-induced acute lung injury in rats. Am J Physiol Lung

Cell Mol Physiol 2005;289:L1131–7.

Syapin PJ. Regulation of haeme oxygenase-1 for treatment of

neuroinflammation and brain disorders. Br J Pharmacol

;155:623–40.

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;121:781–8e1.

Kimm H, Yun JE, Jo J, Jee SH. Low serum bilirubin level as an

independent predictor of stroke incidence: a prospective study in

Korean men and women. Stroke 2009;40:3422–7.

Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie

K, et al. Guidelines for prevention of stroke in patients with

ischemic stroke or transient ischemic attack: a statement for

healthcare professionals from the American Heart

Association/American Stroke Association Council on Stroke: cosponsored by the Council on Cardiovascular Radiology and

Intervention: the American Academy of Neurology affirms the

value of this guideline. Stroke 2006;37:577–617.

NIH Stroke Scale (NIHSS). Available at:

http://www.nihstrokescale.org/docs/NIH_Stroke_Scale.pdf.

Accessed October 20, 2010.

Modified Rankin Scale (mRS). Available at:

http://www.strokecenter.org/trials/scales/modified_rankin.pdf.

Accessed October 20, 2010.

Sedlak TW, Snyder SH. Bilirubin benefits: cellular protection by

a biliverdin reductase antioxidant cycle. Pediatrics

;113:1776–82.

Regino WO, Velasco H, Sandoval H. The protective role of

bilirubin in human beings. Revista Colombiana de

Gastroenterologia 2009;24:293–301.

Pineda S, Bang OY, Saver JL, Starkman S, Yun SW, Liebeskind

DS, et al. Association of serum bilirubin with ischemic stroke

outcomes. J Stroke Cerebrovasc Dis 2008;17(3):147–52.

Dohi K, Mochizuki Y, Satoh K, Jimbo H, Hayashi M, Toyoda I,

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.

Published

2011-06-01

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