Changes of liver enzymes and bilirubin during ischemic stroke: mechanisms and possible significance

Abstract

BackgroundSmall changes of bilirubin and liver enzymes are often detected during the acute phase of stroke, but their origin and significance are still poorly understood.MethodsOn days 0, 3, 7, and 14 after admission, 180 patients with ischemic stroke underwent serial determinations of bilirubin, GOT, GPT, γGT, alkaline phosphatase, C-reactive protein (CRP) and complete blood count. On days 0 and 7 common bile duct diameter was measured by ultrasound, and on day 3 cerebral infarct volume (IV) was calculated from CT scan slices.ResultsDuring the first week GOT, GPT, γGT (P < 0.001) and CRP (P = 0.03) increased with subsequent plateau, while significant decrements (P < 0.001) concerned unconjugated bilirubin, erythrocytes and haemoglobin. Alkaline phosphatase, direct bilirubin and common bile duct diameter remained stable. IV correlated with CRP, leukocytes, GOT, γGT (r > 0.3, P < 0.001 for all) and direct bilirubin (r = 0.23, P = 0.008). In multivariate analysis only CRP and GOT remained independently associated with IV (P < =0.001). The correlation of IV with GOT increased progressively from admission to day 14. GOT independently correlated with GPT which, in turn, correlated with γGT. γGT was also highly correlated with leukocytes. Unconjugated bilirubin correlated with haemoglobin, which was inversely correlated with CRP.ConclusionsThe changes of bilirubin and liver enzymes during ischemic stroke reflect two phenomena, which are both related to IV: 1) inflammation, with consequent increment of CRP, leukocytes and γGT, and decrease of haemoglobin and unconjugated bilirubin and 2) an unknown signal, independent from inflammation, leading to increasing GOT and GPT levels.

Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection

“…As a key marker, CRP demonstrates a consistent response to surgical stress and provides a reliable measure of the overall acute-phase reaction. Postoperative levels of CRP rise at 4-12 h, peak at 24-72 h and return to baseline at about 2 weeks [33,34]. In our study, the level of CRP was significantly lower in the half-Pringle group in comparison with the Pringle group, which demonstrated less surgical trauma in the half-Pringle group.…”

“…The Pringle group was also associated with significantly lower albumin levels on PODs 1 and 3, which also demonstrated better recovery in half-Pringle group. CRP is an acute-phase reactant mainly induced by IL-6 during tissue injury [33,34]. As a key marker, CRP demonstrates a consistent response to surgical stress and provides a reliable measure of the overall acute-phase reaction.…”

De Ritis ratio (AST/ALT) as an independent predictor of poor outcome in patients with acute ischemic stroke

“…Lowering of the blood glutamate level according to the AST and ALT levels could therefore result in the transfer of glutamate from the brain into the peripheral blood (following the concentration gradient) and thereby exert a neuroprotective effect in AIS patients 4–8. Previous studies have also described AST as being associated with the cerebral infarct size and hemorrhagic transformation after AIS 9,10. As a routine noninvasive laboratory test, the AST/ALT ratio (De Ritis ratio, AAR) represents the simultaneous alteration of AST and ALT levels, which has been used to assess the risk of critical limb ischemia in peripheral arterial occlusive disease and nonalcoholic fatty liver disease, and treated as a prognostic marker for diseases such as nonmetastatic renal cell carcinoma and upper urinary tract urothelial carcinoma 11–16…”

Liver function may play an uneven role in haemorrhagic transformation for stroke subtypes after acute ischaemic stroke

“…AST was found to be positively associated with infarct size [14]. AST, however, performed a protective effect by transforming and neutralizing glutamate after ischaemic stroke [32].…”