Serum Alkaline Phosphatase, Phosphate, and In-Hospital Mortality in Acute Ischemic Stroke Patients

Zhong, Chongke; You, Shoujiang; Chen, Juping; Zhai, Guojie; Du, Huaping; Luo, Yi; Dong, Xinghui; Cao, Yongjun; Liu, Chun‐Feng; Zhang, Yonghong

doi:10.1016/j.jstrokecerebrovasdis.2017.08.041

Cited by 35 publications

(46 citation statements)

References 34 publications

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“…Scant information is known as to the potential utility of various biomarkers in predicting mortality, particularly in the acute setting. In particular, biomarkers such as alkaline phosphatase, phosphate, magnesium, BUN and fibrinogen have been shown to have a good correlation within hospital mortality (39-41). This study is the first to date to determine the potential role of elevated NLR in assessing death risk, particularly in the hyper-acute setting.…”

Section: Discussionmentioning

confidence: 99%

Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care

Wijeratne

Sales

Karimi

et al. 2021

Preprint

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Neutrophil counts (innate immunity) and lymphocyte counts (adaptive immunity) are common markers of inflammation in the context of acute stroke, and Neutrophil lymphocyte ratio (NLR) is likely to be expected to predict the post-stroke outcome. This study aimed to explore the predictive value of NLR to predict the very early mortality during the acute hospital admission ( death within the first week of hospital stay ) as this has management implications for the ongoing investigations, family discussions and resource allocation. This the first such study attempting at exploring the role of NLR in hyperacute in-patient mortality in the world to the best of our knowledge. This retrospective study included 120 patients ( 60 acute stroke patients who died within the first week of the hospital stay and 60 age, sex-matched controls who were discharged within two weeks of the hospital admission, alive. We reviewed the total white cell counts of these patients ( first 72 hours of the hospital admission) and NLR was calculated manually. While there was no statistically significant difference between mean neutrophil counts and mean lymphocyte counts between the two cohorts [ neutrophil counts (mean, SD), 8.52(3.20 ) in the death cohort, 6.48(2.20) among survivors and lymphocyte (mean, SD), 1.83(1.48) in the death cohort,1.66 (0.69) among survivors], there was a statistically significant difference in NLR between the two cohorts. NLR (mean, SD) was 6.51 (4.98) in the death cohort while the survivors had mean NLR of 4.64 with an SD 2.90 with a p-value of 0.048. Hypertension, diabetes, atrial fibrillation, previous vascular events were common in both groups indicating the value of exploring the evidence of background compromised vascular system and metabolic syndrome and bringing the systems biology approach to the management of stroke.

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Section: Discussionmentioning

confidence: 99%

Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care

Wijeratne

Sales

Karimi

et al. 2021

Preprint

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“…This study showed an association between increased serum ALP levels and END in patients with ATBI attributable to ICAS. Zhong et al identified a graded relationship between serum ALP levels and risk of early death in patients with acute ischemic stroke [ 9 ]. In the China National Stroke Registry, high serum ALP levels were correlated with increased risk of all-cause mortality, stroke recurrence, composite end point, and poor functional outcomes in patients with stroke and preserved kidney function [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Notably, several pharmacological intervention studies aiming at reducing muscle protein breakdown in this clinical context have shown promising results 11. Overt hypophosphataemia has been previously associated with increased in-hospital mortality in patients with sepsis,12 acute ischaemic stroke13 and community-acquired pneumonia 14. Patients with hypophosphataemia were also found to have longer intensive care unit and hospital stays,2 14 prolonged duration of mechanical ventilation,2 increased risk of arrhythmia and higher rates of respiratory muscle dysfunction 15.…”

Section: Discussionmentioning

confidence: 99%

Normal-range emergency department serum phosphorus levels and all-cause mortality

Barash

Klang

Soffer

et al. 2020

Postgraduate Medical Journal

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Purpose of the studyHypophosphataemia and hyperphosphataemia are frequently encountered in hospitalised patients and are associated with significant clinical consequences. However, the prognostic value of normal-range phosphorus levels on all-cause mortality and hospitalisations is not well established. Therefore, we examined the association between normal-range phosphorus levels, all-cause mortality and hospitalisations in patients presenting to the emergency department of a tertiary medical centre in Israel.Study designA retrospective analysis of patients presenting to the Chaim Sheba Medical Center emergency department between 2012 and 2018. The cohort was divided into quartiles based on emergency department phosphorus levels: ‘very-low-normal’ (p ≥ 2 mg/dL and p ≤ 2.49 mg/dL), ‘low-normal’ (p ≥ 2.5 mg/dL and p ≤ 2.99 mg/dL), ‘high-normal’ (p≥ 3 mg/dL and p≤3.49 mg/dL) and ‘very-high-normal’ (p ≥ 3.5 mg/dL and p ≤ 4 mg/dL). We analysed the association between emergency department phosphorus levels, hospitalisation rate and 30-day and 90-day all-cause mortality.ResultsOur final analysis included 223 854 patients with normal-range phosphorus levels. Patients with ‘very-low-normal’ phosphorus levels had the highest mortality rate. Compared with patients with ‘high-normal’ phosphorus levels, patients with ‘very-low-normal’ levels had increased 30-day all-cause mortality (OR 1.3, 95% CI 1.1 to 1.4, p<0.001), and increased 90-day all-cause mortality (OR 1.2, 95% CI 1.1 to 1.3, p<0.001). Lower serum phosphorus levels were also associated with a higher hospitalisation rate, both for the internal medicine and general surgery wards (p<0.001).ConclusionsLower phosphorus levels, within the normal range, are associated with higher 30-day and 90-day all-cause mortality and hospitalisation rate.

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Serum Alkaline Phosphatase, Phosphate, and In-Hospital Mortality in Acute Ischemic Stroke Patients

Cited by 35 publications

References 34 publications

Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care

Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care

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

Normal-range emergency department serum phosphorus levels and all-cause mortality

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