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

Abstract

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.

Association Between Alkaline Phosphatase and Clinical Outcomes in Patients With Spontaneous Intracerebral Hemorrhage

“…Several different mechanisms underlying the correlation of high serum ALP with poor functional outcome after ICH onset may be considered. First of all, ALP is often used as an early indicator of vascular calcification ( 15 , 30 , 31 ). Vascular calcification can further contribute to the process of atherosclerosis, which in turn results in vascular aging and increases the risk and extent of vessel rupture after stroke ( 7 , 11 , 16 , 18 ).…”

“…Previous studies demonstrated that elevated ALP was associated with all-cause mortality and subsequent cardiovascular disease in myocardial infarction survivors, clinic populations, and general populations (9). Moreover, it has been reported that ALP could predict mortality, functional outcome, and stroke recurrence, especially in those with ischemic stroke (11)(12)(13)(14)(15)(16)(17). However, the role of ALP on clinical outcomes of ICH patients has not been fully interpreted in previous studies conducted in a single center with relatively small cohort, and the underlying mechanism remains unclear.…”

Alkaline phosphatase: a potential biomarker for stroke and implications for treatment

“…Prior clinical studies have explored AP as a diagnostic and prognostic marker to assess stroke risk by correlating indices of AP activity such as: dysfunctional bone metabolism (Barnadas et al 2014;Namba et al, 2017), cardiovascular disease (Webber et al 2010;Kim et al 2017;Makil et al 2017), cancer (Giessen et al 2014;Barnadas et al 2014;Hammerich et al 2017) and periodontitis (Kunjappu et al 2012). More importantly, elevated AP levels in stroke patients have been correlated with stroke severity and hypertension (Pratibha et al 2014;Tan et al 2017). While the underlying molecular mechanisms to support this association are unclear, other studies have provided additional support for this observation.…”

“…Clinical studies have shown that increased AP is associated with risk of cardiovascular disease, one of the many risk factors for stroke (Tonelli et al 2009;Park et al 2013;Wannamethee et al 2013;Kunutsor et al 2014). Elevated AP levels are correlated with more vascular deaths and recurrent vascular events, suggesting that AP may be a predictor for mortality in stroke patients (Pratibha et al 2014;Tan et al 2017). Abnormal AP has been associated with many of the risk factors leading to stroke, including heavy drinking (Ebuehi and Asonye 2007;Shimizu et al 2013a), obesity (Menahan et al 1985;Golik et al 1991), and hypertension (Shimizu et al 2013b).…”

“…To prevent these outcomes, administration of an AP inhibitor has been suggested as one potential therapeutic option. Research from Pratibha and colleagues suggests that administration of AP inhibitors could be used to prevent cerebral ischemia in high-risk populations (Pratibha et al 2014). A study in stroke-prone rats found beneficial effects against cardiovascular disease complications using a traditional fungal medicine and found that the number of capillaries that expressed AP in the heart was significantly decreased compared to untreated rats.…”