Prognostic values of serum alkaline phosphatase and globulin levels in patients undergoing intravenous thrombolysis

Zhu, Huang; Sun, Xin; Guo, Zhen‐Ni; Qu, Yang; Sun, Yingying; Jin, Hang; Wang, Meiqi; Xu, Biao; Yang, Yi

doi:10.3389/fnmol.2022.932075

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…Furthermore, Zhong et al ( 22 ) observed similar results in their study of 2,944 enrolled AIS patients. We also performed an analysis of poor functional outcomes, and similar to Zhu et al and Kim et al, we found that higher ALP levels were associated with an increased risk of poor functional outcomes ( 11 , 19 ). However, Guo et al and Liu et al found that elevated ALP levels were not associated with poor functional outcomes in stroke patients ( 18 , 20 ).…”

Section: Discussionsupporting

confidence: 74%

“…Inhibition of ALP has been shown to prevent the formation of vascular atherosclerosis ( 8 ). Traditionally recognized as a marker for skeletal or hepatobiliary dysfunction ( 9 , 10 ), ALP is now considered indicative of atherosclerosis and inflammatory responses ( 6 , 11 ). Studies have indicated that elevated serum ALP levels are linked to increased atherosclerosis in coronary and peripheral arteries and that higher ALP levels are independently associated with the risk of cardiovascular disease (CVD) and mortality events ( 12 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Impact of alkaline phosphatase on clinical outcomes in patients with ischemic stroke: a nationwide registry analysis

Wang,

Li,

Jing

et al. 2024

Front. Neurol.

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BackgroundData on the association between serum alkaline phosphatase (ALP) levels and clinical outcomes in patients with ischemic stroke (IS) are inconsistent and limited. Therefore, this study aimed to investigate the correlation between ALP and prognosis in patients with IS.MethodsPatients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) from the Third China National Stroke Registry were divided into four groups according to the quartiles of serum ALP levels on admission. Cox proportional hazards and logistic regression models were used to evaluate the correlation between ALP and the risk of all-cause mortality, disability (modified Rankin Scale (mRS) score 3–5), and poor functional outcomes (mRS score 3–6).ResultsA total of 11,405 patients were included in the study. Higher levels of ALP were associated with all-cause mortality at 3 months (adjusted hazard ratio [HR] per standard deviation [SD]: 1.16; 95% confidence interval (CI): 1.07–1.27; p = 0.001) and 1 year (adjusted HR: 1.11; 95% CI: 1.03–1.20; p = 0.010). At the 3-month follow-up, each SD increase of ALP was associated with a 12 and 14% higher risk of disability (adjusted odds ratio (OR): 1.12; 95% CI: 1.06–1.18; p < 0.001) and poor functional outcomes (adjusted OR: 1.14; 95% CI: 1.08–1.20; p < 0.001). Similar results were observed at the 1-year follow-up. Higher ALP levels were associated with an increased risk of all-cause mortality, disability, and poor functional outcomes in patients with “others” subtypes (including other determined etiology and undetermined etiology) (p < 0.05).ConclusionElevated ALP levels were associated with an increased risk of all-cause mortality, disability, and poor function outcomes in patients with IS. Heterogeneity was observed among the subtypes of different etiologies.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Impact of alkaline phosphatase on clinical outcomes in patients with ischemic stroke: a nationwide registry analysis

Wang,

Li,

Jing

et al. 2024

Front. Neurol.

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“…Accordingly, an ideal stroke biomarker should be capable of predicting stroke prognosis and facilitating therapeutic stratification and monitoring ( 5 ), for example by indicating risk of hemorrhagic transformation after stroke or after tissue type plasminogen activator treatment (rt-PA). In fact, Zhu et al ( 25 ) already demonstrated that higher serum ALP levels were independently associated with a poor outcome in patients after intravenous thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Alkaline phosphatase and mortality in stroke patients: a systematic review

Pinto,

Ferreira,

Margarido

et al. 2023

Ann Transl Med

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Background Increased plasma levels of alkaline phosphatase (ALP) have been associated to a worse prognosis in several types of diseases. In the present review, the authors aimed to study the relationship between plasma levels of ALP and overall mortality in patients with stroke. Methods A systematic review was carried out, searching two databases: Web of Science and Medline/PubMed. Results A total of nine studies that included data on overall mortality in stroke patients were selected. The selected studies were published between 2010 and 2022 and were predominantly from Asia. The articles reviewed quantified ALP levels through different methods: highest versus lowest quintiles of plasma ALP (three reports); highest versus lowest quartiles of plasma ALP (four reports); and plasma ALP levels in deceased versus in surviving patients (two reports). All selected studies showed an increased mortality associated to elevated ALP levels, irrespective of stroke type and length of follow-up, from a mean of 10 days to 2.5 years. The studies comparing the highest to the lowest ALP quintiles showed an aggregate value of 1.8 times greater risk of mortality for the former, when compared to the latter. Whereas, the studies comparing the highest to the lowest ALP quartiles showed an aggregate value of 2.4 times greater risk of mortality for the former, when compared to the latter. Conclusions Elevated ALP levels are associated with increased mortality in stroke patients and provide cost effective prognostic indicators of mortality in stroke.

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Clinical decision support systems for 3-month mortality in elderly patients admitted to ICU with ischemic stroke using interpretable machine learning

Huang,

Liu,

Jin

2024

DIGITAL HEALTH

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Background Elderly patients are more likely to suffer from severe ischemic stroke (IS) and have worse outcomes, including death and disability. We aimed to develop and validate predictive models using novel machine learning algorithms for the 3-month mortality in elderly patients with IS admitted to the intensive care unit (ICU). Methods We conducted a retrospective cohort study. Data were extracted from Medical Information Mart for Intensive Care (MIMIC)-IV and International Stroke Perfusion Imaging Registry (INSPIRE) database. Ten machine learning algorithms including Categorical Boosting (CatBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Network (NN), Gradient Boosting Machine (GBM), K-Nearest Neighbors (KNNs), Multi-Layer Perceptron (MLP), Naive Bayes (NB), eXtreme Gradient Boosting (XGBoost) and Logistic Regression (LR) were used to build the models. Performance was measured using area under the curve (AUC) and accuracy. Finally, interpretable machine learning (IML) models presenting as Shapley additive explanation (SHAP) values were applied for mortality risk prediction. Results A total of 1826 elderly patients with IS admitted to the ICU were included in the analysis, of whom 624 (34.2%) died, and endovascular treatment was performed in 244 patients. After feature selection, a total of eight variables, including minimum Glasgow Coma Scale values, albumin, lactate dehydrogenase, age, alkaline phosphatase, body mass index, platelets, and types of surgery, were finally used for model construction. The AUCs of the CatBoost model were 0.737 in the testing set and 0.709 in the external validation set. The Brier scores in the training set and testing set were 0.12 and 0.21, respectively. The IML of the CatBoost model was performed based on the SHAP value and the Local Interpretable Model-Agnostic Explanations method. Conclusion The CatBoost model had the best predictive performance for predicting mortality in elderly patients with IS admitted to the ICU. The IML model would further aid in clinical decision-making and timely healthcare services by the early identification of high-risk patients.

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Prognostic values of serum alkaline phosphatase and globulin levels in patients undergoing intravenous thrombolysis

Cited by 3 publications

References 32 publications

Impact of alkaline phosphatase on clinical outcomes in patients with ischemic stroke: a nationwide registry analysis

Impact of alkaline phosphatase on clinical outcomes in patients with ischemic stroke: a nationwide registry analysis

Alkaline phosphatase and mortality in stroke patients: a systematic review

Clinical decision support systems for 3-month mortality in elderly patients admitted to ICU with ischemic stroke using interpretable machine learning

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