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

Tan, Ge; Lei, Chunyan; Zeng, Hao; Chen, Y.; Yuan, Ruozhen; Liu, M.

doi:10.1111/ene.12904

Cited by 22 publications

(13 citation statements)

References 37 publications

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“…The liver dysfunction has been found to contribute to hematoma expansion in spontaneous ICH (38)(39)(40)(41) and HT in AIS (42). In addition, the HAS-BLED score, which includes liver dysfunction as a fundamental item, is widely used for evaluating hemorrhagic risk (43).…”

Section: Discussionmentioning

confidence: 99%

Liver Fibrosis Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

et al. 2020

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Background: Hemorrhagic transformation (HT) is a frequent, often asymptomatic event that occurs after acute ischemic stroke (AIS). Liver fibrosis, usually subclinical, is common and crucial in the development of liver disease. We aimed to investigate the association between liver fibrosis and HT in patients with AIS. Methods: We performed a single-center and retrospective study. A total of 185 consecutive participants with HT and 199 age-and sex-matched stroke patients without HT were enrolled in this study. We calculated one validated fibrosis index-Fibrosis-4 (FIB-4) score-to assess the extent of liver fibrosis. HT was detected by routine CT or MRI and was radiologically classified as hemorrhagic infarction type 1 or 2 or parenchymal hematoma type 1 or 2. HT was also classified into asymptomatic or symptomatic. We used logistic regression models adjusted for previously established risk factors to assess the risks for HT. Results: The median FIB-4 score was significantly higher among patients who developed HT than among those without HT, whereas standard hepatic assays were largely normal. Patients were assigned to groups of high FIB-4 score and low FIB-4 score based on the optimal cutoff value. Compared with the subjects in the low-FIB-4-score group, incidence of HT for the high-FIB-4-score group was significantly higher. After adjustment for potential confounders, the patients with high FIB-4 score had 3.461-fold risk of HT in AIS compared to the patients with low FIB-4 score [odds ratio, 3.461 (95% CI, 1.404-8.531)]. Conclusion: Liver fibrosis, measured by FIB-4 score, was independently associated with the risk of HT in AIS patients.

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Section: Discussionmentioning

confidence: 99%

Liver Fibrosis Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

et al. 2020

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“…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…”

Section: Introductionmentioning

confidence: 99%

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

Gao¹,

Chen²,

Lu³

et al. 2017

NDT

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PurposeThe aspartate transaminase/alanine transaminase ratio (De Ritis ratio, AAR) was reported to be associated with patients’ prognosis in certain diseases recently. The objective of the current study was to determine the association between the AAR at admission and poor outcome at 3 months in acute ischemic stroke (AIS) patients.Patients and methodsThis retrospective cohort study included patients who experienced their first-ever AIS between June 2015 and March 2016. The primary outcome measure was a poor outcome at 3 months (modified Rankin Scale score >2). Multivariate logistic regression models were used to assess the relationship between AAR quartiles and clinical outcomes among the AIS patients. Receiver operating characteristic curve analysis was applied to identify the optimal cutoff for AAR in predicting the prognosis of AIS.ResultsIn terms of the relationship between poor outcome and AAR, the adjusted odds ratio comparing the highest and lowest AAR quartiles was 2.15 (95% confidence interval =1.14–4.05). An AAR of 1.53 was identified as the optimal cutoff. In a prespecified subgroup analysis according to the time from symptom onset to treatment (>24 vs ≤24 hours), there was no significant difference in the effect of AAR >1.53 between the two groups.ConclusionAn increased AAR at admission is significantly associated with a poor outcome at 3 months in AIS patients.

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“…[ 22 ] According to previous studies, some liver function indicators play an important role in hemorrhagic complications. [ 23 , 24 ] For example, alkaline phosphatase, bilirubin and gamma glutamyl transpeptidase may play a harmful role in the prognosis of hemorrhagic complications through aggravating inflammation reaction, damaging cerebral vessels or enlarging edema after stroke. [ 23 , 25 ] However, other indicators such as ALT and aspartate aminotransferase were found to have neuroprotective effects and may improve the prognosis of hemorrhagic complications.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients

Zeng

Chen

et al. 2021

Medicine

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For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients. Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed. Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group ( P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06–7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10–0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06–0.45 P = .000) were protective factors of hemorrhagic complications. For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.

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

Cited by 22 publications

References 37 publications

Liver Fibrosis Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

Liver Fibrosis Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

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

Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients

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