Association of serum neuron‐specific enolase and bilirubin levels with cerebral dysfunction and prognosis in large‐artery atherosclerotic strokes

Abstract

High serum NSE levels and hyperbilirubinemia might be biomarkers for a poor prognosis in the early identification of LAA strokes.

Serum bilirubin and ischaemic stroke: a review of literature

“…After stroke occurs, the negative influence of high levels of serum bilirubin on patients’ outcome possibly reflects the intensity of initial oxidative stress. AIS patients with higher levels of bilirubin had larger cerebral infarcts, more prominent brain oedema and more severe reperfusion injuries with poorer functional outcomes than those with lower bilirubin levels 55. On the other hand, elevated bilirubin can protect neurons from oxidative stress injury within a certain concentration range, and the underlying mechanism has been well illustrated previously.…”

“… 54 From 73 patients with LAA stroke, Wang et al found that the level of TBIL (direct bilirubin (DBIL), indirect bilirubin) was positively associated with stroke severity (NIHSS score) on day 1, 7 and 14, as well as with poor functional outcomes (mRS score) on day 30. 55 Other studies also showed that both levels of serum DBIL and TBIL were positively correlated with stroke severity 3 56–58 and poor prognoses 59 60 in AIS. Another study reported that patients with higher DBIL levels had significantly greater NIHSS scores on admission than those with lower levels of DBIL, whereas TBIL did not show this type of correlation.…”

“…Kurzepa et al reported that the level of TBIL in the acute phase of IS proved to be a bad prognostic factor not only for early neurological status (NIHSS score) but also for long term neurological functions (Barthel Index score) measured 3 months after stroke onset 54. From 73 patients with LAA stroke, Wang et al found that the level of TBIL (direct bilirubin (DBIL), indirect bilirubin) was positively associated with stroke severity (NIHSS score) on day 1, 7 and 14, as well as with poor functional outcomes (mRS score) on day 30 55. Other studies also showed that both levels of serum DBIL and TBIL were positively correlated with stroke severity3 56–58 and poor prognoses59 60 in AIS.…”

“…However, a high concentration of unconjugated bilirubin can be cytotoxic, increasing the permeability of the mitochondrial membrane, damaging mitochondrial function as well as decreasing the activity of astrocytes. As a result, increased neurocyte apoptosis was observed 55 66. Therefore, pathological levels of bilirubin serve as an indicator of severe brain injury and poor prognosis, whereas high levels of bilirubin in the normal range might be an indicator of good neurological outcome.…”

“…It was proposed that stroke severity at admission was a strong confounding factor influencing the prognosis of stroke patients,67 suggesting that initial stroke severity may be a mediator of the relationship between the level of serum bilirubin and the prognosis of IS patients. Based on these findings, it is possible that a high level of bilirubin might be associated with improved stroke outcome35 after excluding stroke patients with liver dysfunction, adjusting for alcohol intake and initial stroke severity 53–55 59 60…”