Serum bilirubin levels are associated with poor functional outcomes in patients with acute ischemic stroke or transient ischemic attack

Abstract

Background The prognostic value of serum bilirubin in stroke is controversial, since bilirubin has both neuroprotective and neurotoxic properties. We aimed to investigate the association between serum bilirubin, including total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) and poor functional outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods All patients with AIS or TIA were recruited from the Third China National Stroke Registry. The poor functional outcomes included modified Rankin Scale (mRS) score 2–6 and 3–6 at 3 months and 1 year. Multivariable logistic regression was used to investigate the associations of TBIL, DBIL, and IBIL with poor functional outcomes. Results Among 11,121 enrolled patients, the median (interquartile range) of TBIL, DBIL, and IBIL was 13.30 (9.90–17.70), 3.80 (2.70–5.30), and 9.30 (6.70–12.80) µmol/L. After adjustment for conventional confounding factors, patients in the highest TBIL quartile had the highest proportion of mRS score 2–6 at 3 months (odds ratio [OR], 1.37; 95 % confidence interval [CI], 1.19–1.59) and 1 year (OR, 1.31; 95 % CI, 1.13–1.52), and mRS score 3–6 at 3 months (OR, 1.33; 95 % CI, 1.11–1.59) and 1 year (OR, 1.28; 95 % CI, 1.07–1.53), when compared to patients in the lowest TBIL quartile. Similar results were observed for DBIL and IBIL. We also found J-shaped associations between serum bilirubin levels and each outcome. Conclusions Elevated levels of serum bilirubin were significantly associated with poor functional outcomes in patients with AIS or TIA at 3 months and 1 year.

Circulating Total Bilirubin and Long-Term Prognosis in Patients With Previous Myocardial Infarction

“… 5 , 6 , 7 Clinically, circulating total bilirubin (TBil) has been traditionally considered a potentially toxic metabolite and a marker for the diagnosis of some liver diseases. 8 , 9 , 10 However, the latest evidence supports that TBil within the normal physiologic range is a potent endogenous antioxidant with anti-inflammatory, immunomodulatory, antithrombotic, and endocrine properties, 8 which may likely contribute to the protective effect on oxidative stress diseases including diabetes, 11 stroke, 12 peripheral arterial disease, 13 heart failure (HF), 14 and CVD. 15 Many epidemiological studies assessed the clinical significance and prognostic value of TBil, but the results were inconsistent.…”

Higher baseline serum bilirubin levels are associated with increased risk of early neurological deterioration in women with acute ischemic stroke

“…Kurzepa et al ( 22 ) observed a negative correlation between TBIL level and 3-month Barthel index (r = −0.5, p < 0.01). Ouyang et al ( 23 ) reported that elevated bilirubin was associated with poor functional outcome at 3 months and 1 year in patient with AIS or TIA. Sagheb Asl et al ( 24 ) showed that TBIL, DBIL and IBIL levels were significantly associated with mortality in the acute phase of ischemic stroke.…”

Higher serum bilirubin levels are associated with hemorrhagic transformation after intravenous thrombolysis in acute ischemic Stroke

“…A few studies reported that patients with AIS with elevation of serum bilirubin levels had lower risk of early neurological deterioration ( Sheng et al, 2021 ) and increased odds of good functional outcomes ( Duan et al, 2022 ). However, more studies revealed that elevated serum bilirubin levels were independent predictors of poor functional outcome after AIS ( Wang et al, 2018 ; Ouyang et al, 2021 ; Peng et al, 2022 ). The findings suggest the predominant role of bilirubin in acute stage of ischemic stroke is a prooxidant, which support our research results.…”