Increased serum alkaline phosphatase and early neurological deterioration in patients with atherothrombotic brain infarction attributable to intracranial atherosclerosis

Abstract

Objective The purpose of this study was to determine whether increased alkaline phosphatase (ALP) was associated with early neurological deterioration (END) in patients with atherothrombotic brain infarction (ATBI) attributable to intracranial atherosclerosis (ICAS) or not. Methods We analyzed data derived from 70 patients (47 men; mean age, 72.4 ± 12.8 years) with symptomatic ICAS who were admitted within 3 days of ATBI onset between April 2013 and December 2018. We defined END as an increase of ≥2 in the National Institutes of Health Stroke Scale scores during the first 72 h of hospitalization. Results Eleven (15.7%) patients had END. Serum ALP levels on admission were significantly higher among patients with, than without END (median [interquartile range], 296 [233–338] vs. 216 [187–262] U/L, p = .0081). Conclusion Increased serum ALP levels on admission may be able to predict developing END in patients with symptomatic ICAS.

Increased Serum Alkaline Phosphatase and Functional Outcome in Patients with Acute Ischemic Stroke Presenting a Low Ankle–Brachial Index

“…In a community-based prospective cohort study of a Middle Eastern population, the brachial-ankle pulse wave velocity 7,8) . Uehara et al previously reported that a high serum ALP level at admission was a predictor of subsequent ischemic stroke events in patients with transient ischemic attack attributable to intracranial atherosclerosis 20) and that increased serum ALP levels at admission predicted the development of early neurological deterioration in patients with symptomatic intracranial atherosclerosis 21) . In addition, Cheung BM, et al reported that elevated serum ALP levels correlated with PAD, independent of other cardiovascular risk factors, in the general Chinese population aged ≥ 40 years, but a low ABI The factors that were associated with poor stroke outcome, except for stroke subtypes, were selected by a backward selection procedure using p＞ 0.10 of the likelihood ratio as the exclusion criterion.…”

A Systematic Review of Body Fluids Biomarkers Associated With Early Neurological Deterioration Following Acute Ischemic Stroke

“…The related mechanism concerned neuroinflammation and the immature and unstable vasculature ( Liu et al, 2016 ). Uehara et al (2020) recently found that the elevated serum ALP level on admission may predict END in symptomatic intracranial atherosclerotic cerebral infarction. The results were only statistically significant in the symptomatic intracranial artery stenosis group, not in the symptomatic intracranial artery occlusion group.…”

“…These results suggest that END is due to inter-arterial re-embolization of vulnerable plaques resulting from symptomatic intracranial atherosclerosis rather than a hemodynamic mechanism due to occlusion. Increased ALP level is a surrogate marker of instability in symptomatic intracranial artery stenosis plaques ( Uehara et al, 2020 ). Considering the multifunction of ALP, further investigations are needed to discover the potential significance of AIS progression.…”

Non-Linear Association Between Serum Alkaline Phosphatase and 3-Month Outcomes in Patients With Acute Stroke: Results From the Xi'an Stroke Registry Study of China

“…One working hypothesis is that elevated ALP may accelerate the calcification and stiffening of vessels, decrease vascular compliance and cause atherosclerosis (9,18,29). Elevated ALP levels were also hypothesized to trigger systemic inflammation, subsequently leading to adverse stroke outcomes (30,31). CD34-positive cells play an important role in maintaining vascular homeostasis and repair (32)(33)(34).…”