Increased serum alkaline phosphatase as a predictor of long-term mortality after stroke

Ryu, Wi‐Sun; Lee, Jun Young; Kim, C. K.; Kim, Beom Joon; Yoon, Byung-Woo

doi:10.1212/wnl.0b013e3181ff966a

Cited by 75 publications

(93 citation statements)

References 26 publications

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“…11 That study examined 2,029 participants with acute stroke and showed that higher ALP was associated with both all-cause mortality and vascular mortality in either ischemic or hemorrhagic stroke. Moreover, Park et al reported that higher ALP was an independent predictor of mortality, MI, and stent thrombosis in 1,636 patients who underwent PCI.…”

Section: Discussionmentioning

confidence: 99%

“…7-9 Furthermore, higher ALP is related to adverse outcome among survivors of myocardial infarction (MI) 10 or stroke. 11 In a recent study, higher ALP predicted mortality, MI, and stent thrombosis after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). 12 Considering that vascular calcification hampers the process of re-endothelialization, ALP may contribute to stent thrombosis after PCI whereas coronary artery bypass grafting (CABG) uses the endothelialized vein or artery for the graft.…”

Section: Subjectsmentioning

confidence: 99%

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Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Kim

Hong

Choi

et al. 2017

Circ J

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Background: Serum alkaline phosphatase (ALP) is related to vascular calcification. In a recent study on percutaneous coronary intervention (PCI) with a drug-eluting stent, higher ALP was associated with poor clinical outcomes in terms of mortality, myocardial infarction, and stent thrombosis. The aim of this study was to evaluate the relationship between preoperative ALP and clinical outcome of off-pump coronary artery bypass surgery (OPCAB). Methods and Results:We retrospectively enrolled and reviewed a total of 1,335 patients who underwent OPCAB. Patients were divided into tertiles based on preoperative serum ALP (<60, 60-76, and >76 IU/L). As preoperative ALP increased, the HR of mortality remained constant after adjusting for confounders. On Cox proportional hazards regression analysis, there was no association between ALP and all-cause mortality. The adjusted HR for all-cause mortality for the middle tertile was 0.882 (95% CI: 0.592-1.314, P=0.537), and 0.915 (95% CI: 0.605-1.383, P=0.672) for the highest tertile. In addition, no associations between ALP and cardiovascular mortality, myocardial infarction, revascularization, or major adverse cardiac events were found.Conclusions: Unlike after PCI, high ALP is not related to adverse clinical events, such as mortality, myocardial infarction, or revascularization after OPCAB. ALP might be considered when determining the optimal revascularization technique.

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Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Kim

Hong

Choi

et al. 2017

Circ J

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“…We evaluated recurrent vascular events also, apart from mortality, which was not done in the previous study [12]. By this observation, we can derive that serum ALP and phosphate definitely indicate vascular morbidity apart from the other mechanisms mentioned above.…”

Section: Discussionmentioning

confidence: 96%

“…Such studies have been limited in stroke population. One such study was carried out in Korea in patients with stroke [12] to evaluate serum ALP and phosphate as predictors of mortality and recurrent vascular events. It proved that serum ALP and phosphate can be predictor of mortality in stroke, both ischemic and haemorrhagic.…”

Section: Discussionmentioning

confidence: 99%

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Increased Serum Alkaline Phosphatase and Serum Phosphate as Predictors of Mortality after Stroke

2014

JCDR

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Context: Serum Alkaline phosphatase (ALP) & phosphate are considered to be indicators of vascular calcification. Link between bone metabolism, vascular calcification, cardiovascular events have been well studied in chronic kidney disease and ischemic heart disease.Aims: To determine that increased serum phosphate and alkaline phosphatase are predictors of mortality rates and recurrent vascular events in stroke. Materials and Methods:Sixty patients admitted with acute stroke (ischemic & haemorrhagic) were included in the study. Their baseline clinical characteristics and biochemical parameters including serum ALP and phosphate were noted. All patients were followed up for a period of one year. The all-cause mortality, the mortality due to cardiovascular events and recurrent vascular events without death were noted during the follow up. Statistical analyses were done to look for any correlation between mortality and baseline levels of serum ALP and phosphate.Results: Of the 60 patients, 8 (13.3%) patients were lost for follow up. Fourteen (26.9%) patients died; of which 12 deaths were due to vascular causes and 2 deaths were due to non vascular causes. Increasing levels of serum ALP and phosphate correlated with all cause mortality and recurrent vascular events without death Conclusion: Serum ALP and phosphate prove to be cost effective prognostic indicator of mortality and recurrent vascular events in stroke. This finding has to be confirmed with studies including larger population. Further research on ALP inhibitors, Vitamin D analogues and phosphate binders to improve mortality in stroke population can be encouraged.

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Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage

et al. 2016

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Whether subclinical change of liver function is associated with outcome of spontaneous intracerebral hemorrhage remains to be an open question. A total of 639 patients of spontaneous intracerebral hemorrhage within 7 days from stroke onset were finally enrolled. Liver function indicators, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin (BIL), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), albumin (ALB), and international normalized ratio (INR), were collected and collapsed into quartiles. The main outcomes were 30-day death, 90-day death, and 90-day poor outcome (modified Rankin Scale score of 3-6). Two adjusted model, Model 1 and Model 2 (Model 1 plus GCS score), were established to identify independent association between liver function indicators and ICH outcomes. The mortality rate was 19.9 % (127/639) at 30 days and 21.3 % (136/639) at 90 days. Rate of 90-day poor outcome was 51.5 % (329/639). Among liver function indicators, AST and ALP were associated with all the three outcomes, which did not alter significantly when adjusted by Model 1. After adjusted by Model 2, ALP was still associated with outcomes. Association between AST and outcomes was, however, weakened significantly by GCS score. In conclusions, among liver function indicators, AST and ALP were associated with outcomes after spontaneous intracerebral hemorrhage.

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Increased serum alkaline phosphatase as a predictor of long-term mortality after stroke

Abstract: Our study demonstrated that increased serum levels of alkaline phosphatase are an independent predictor of all-cause and vascular death after either ischemic or hemorrhagic stroke.

Cited by 75 publications

References 26 publications

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Increased Serum Alkaline Phosphatase and Serum Phosphate as Predictors of Mortality after Stroke

Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage

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