Correlation of Serum Bilirubin with Severity of Acute Ischemic Stroke
Serum Bilirubin with Severity of Acute Ischemic Stroke
DOI:
https://doi.org/10.54393/pjhs.v6i4.2845Keywords:
Ischemic Stroke, Stroke Severity, Serum Bilirubin, National Institute of Health Stroke ScaleAbstract
Serum bilirubin is associated with stroke severity, existing data on this relationship remain limited and inconclusive. Objectives: To determine the correlation between serum bilirubin and the National Institute of Health stroke scale score in patients with acute ischemic stroke. Methods: This cross-sectional study was done at the Medical Emergency of Mayo Hospital Lahore from June 2022 to December 2022. A total of 205 patients suffering from acute ischemic stroke were included. Serum bilirubin was obtained within 24 hours of the onset of stroke at presentation, and stroke severity was assessed same time using NIHSS. Data analysis was done using SPSS version 26.0. Pearson correlation was determined between serum bilirubin and NIHSS score at presentation. Results: In current study population, 44.5% of patients were diabetics, 77.6% were hypertensive, and 27.8% were smokers. Mean serum bilirubin level was 0.98 ± 0.19 mg/dL, and mean NIHSS score is 19.51 ± 8.94, Pearson correlation coefficient between bilirubin and NIHSS is -0.082, p-value=0.240, statistically not significant. Conclusions: It was concluded that in our study, a weak negative correlation was observed between serum bilirubin levels and NIHSS scores in patients with acute ischemic stroke. This suggests that higher bilirubin levels may have a slight protective effect, as stroke severity (NIHSS scores) tended to decrease minimally with increasing bilirubin levels.
References
Murphy SJ and Werring DJ. Stroke: Causes and Clinical Features. Medicine. 2020 Sep; 48(9): 561-6. doi: 10.1016/j.mpmed.2020.06.002. DOI: https://doi.org/10.1016/j.mpmed.2020.06.002
Walter K. What is Acute Ischemic Stroke? Journal of the American Medical Association. 2022 Mar; 327(9): 885-. doi: 10.1001/jama.2022.1420. DOI: https://doi.org/10.1001/jama.2022.1420
Powers WJ. Acute Ischemic Stroke. New England Journal of Medicine. 2020 Jul; 383(3): 252-60. doi: 10.1056/NEJMcp1917030. DOI: https://doi.org/10.1056/NEJMcp1917030
Saini V, Guada L, Yavagal DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology. 2021 Nov; 97(20_Supplement_2): S6-16. doi: 10.1212/WNL.0000000000012781. DOI: https://doi.org/10.1212/WNL.0000000000012781
Zaidi DA, Yaqoob E, Chaurasia B, Javed S. Addressing Stroke Care Deficiencies in Pakistan: A Call for Nationwide Reforms and Strategic Initiatives. Neurosurgical Review. 2024 Aug; 47(1): 396. doi: 10.1007/s10143-024-02648-x. DOI: https://doi.org/10.1007/s10143-024-02648-x
Vitek L, Hinds TD, Stec DE, Tiribelli C. The Physiology of Bilirubin: Health and Disease Equilibrium. Trends in Molecular Medicine. 2023 Apr; 29(4): 315-28. doi: 10.1016/j.molmed.2023.01.007. DOI: https://doi.org/10.1016/j.molmed.2023.01.007
Ouyang Q, Wang A, Tian X, Zuo Y, Liu Z, Xu Q, Meng X, Chen P, Li H, Wang Y. Serum Bilirubin Levels Are Associated with Poor Functional Outcomes in Patients with Acute Ischemic Stroke or Transient Ischemic Attack. BioMed Central Neurology. 2021 Dec; 21: 1-2. doi: 10.1186/s12883-021-02398-z. DOI: https://doi.org/10.1186/s12883-021-02398-z
Zhao K, Wang R, Chen R, Liu J, Ye Q, Wang K, Li J. Association Between Bilirubin Levels with Incidence and Prognosis of Stroke: A Meta-Analysis. Frontiers in Neuroscience. 2023 Feb; 17: 1122235. doi: 10.3389/fnins.2023.1122235. DOI: https://doi.org/10.3389/fnins.2023.1122235
Jayanti S, Moretti R, Tiribelli C, Gazzin S. Bilirubin and Inflammation in Neurodegenerative and Other Neurological Diseases. Neuro-immunology and Neuro-inflammation. 2020; 2020(7): 92-108. doi: 10.20517/2347-8659.2019.14. DOI: https://doi.org/10.20517/2347-8659.2019.14
Wang G, Qiao L, Tang Z, Zhou S, Min J, Li M. Association Between Bilirubin Levels and Risk of Stroke: A Systematic Review and Meta-Analysis. British Medical Journal Open. 2023 May; 13(5): e064433. doi: 10.1136/bmjopen-2022-064433. DOI: https://doi.org/10.1136/bmjopen-2022-064433
Wang J, Zhang X, Zhang Z, Zhang Y, Zhang J, Li H et al. Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients. Journal of the American Heart Association. 2020 Jun; 9(12): e015799. doi: 10.1161/JAHA.119.015799. DOI: https://doi.org/10.1161/JAHA.119.015799
Luo Y, Li JW, Lu ZJ, Wang C, Guan DN, Xu Y. Serum Bilirubin After Acute Ischemic Stroke Is Associated with Stroke Severity. Current Neurovascular Research. 2012 May; 9(2): 128-32. doi: 10.2174/156720212800410876. DOI: https://doi.org/10.2174/156720212800410876
Khan MS, Ahmad S, Ghafoor B, Shah MH, Mumtaz H, Ahmad W et al. Inpatient Assessment of the Neurological Outcome of Acute Stroke Patients Based on the National Institute of Health Stroke Scale (NIHSS). Annals of Medicine and Surgery. 2022 Oct; 82. doi: 10.1016/j.amsu.2022.104770. DOI: https://doi.org/10.1016/j.amsu.2022.104770
Béjot Y, Duloquin G, Thomas Q, Mohr S, Garnier L, Graber M et al. Temporal Trends in the Incidence of Ischemic Stroke in Young Adults: Dijon Stroke Registry. Neuro-epidemiology. 2021 Jun; 55(3): 239-44. doi: 10.1159/000516054. DOI: https://doi.org/10.1159/000516054
Kanwal S, Yousaf Q, Jamil A, Arshad W, Qadir M, Tahir MU et al. Association Between Acute Ischemic Stroke and Raised Serum Gamma Glutamyl Transferase: Association Between Acute Ischemic Stroke and Serum Gamma Glutamyl Transferase. Pakistan Journal of Health Sciences. 2024 Sep: 27-31. doi: 10.54393/pjhs.v5i09.2031. DOI: https://doi.org/10.54393/pjhs.v5i09.2031
Schaefer J, Bohmann FO, Misselwitz B, Foerch C. Diverging Time Trends of Gender-specific Ischemic Stroke Incidence-10-year-analysis of A State-wide Registry in Germany. Stroke. 2022 Feb; 53(Suppl_1): A60-. doi: 10.1161/str.53.suppl_1.60. DOI: https://doi.org/10.1161/str.53.suppl_1.60
Yi X, Luo H, Zhou J, Yu M, Chen X, Tan L et al. Prevalence of Stroke and Stroke Related Risk Factors: A Population Based Cross Sectional Survey in Southwestern China. BioMed Central Neurology. 2020 Dec; 20: 1-0. doi: 10.1186/s12883-019-1592-z. DOI: https://doi.org/10.1186/s12883-019-1592-z
Xing L, Jing L, Tian Y, Liu S, Lin M, Du Z et al. High Prevalence of Stroke and Uncontrolled Associated Risk Factors Are Major Public Health Challenges in Rural Northeast China: A Population-Based Study. International Journal of Stroke. 2020 Jun; 15(4): 399-411. doi: 10.1177/1747493019851280. DOI: https://doi.org/10.1177/1747493019851280
Song Y, Zhang X, Li C, Xu S, Zhou B, Wu X. Is Bilirubin Associated with the Severity of Ischemic Stroke? A Dose Response Meta-Analysis. Journal of Clinical Medicine. 2022 Jun; 11(12): 3262. doi: 10.3390/jcm11123262. DOI: https://doi.org/10.3390/jcm11123262
Yu F, Zhang L, Liao D, Luo Y, Feng X, Liu Z et al. Serum Bilirubin Levels and Extent of Symptomatic Intracranial Atherosclerotic Stenosis in Acute Ischemic Stroke: A Cross-Sectional Study. Frontiers in Neurology. 2021 Aug; 12: 714098. doi: 10.3389/fneur.2021.714098. DOI: https://doi.org/10.3389/fneur.2021.714098
Peng Q, Bi R, Chen S, Chen J, Li Z, Li J et al. Predictive Value of Different Bilirubin Subtypes for Clinical Outcomes in Patients with Acute Ischemic Stroke Receiving Thrombolysis Therapy. Cognitive Neuroscience Society Neuroscience and Therapeutics. 2022 Feb; 28(2): 226-36. doi: 10.1111/cns.13759. DOI: https://doi.org/10.1111/cns.13759
Duan H, Cheng Z, Yun HJ, Cai L, Tong Y, Han Z et al. Serum Bilirubin Associated with Stroke Severity and Prognosis: Preliminary Findings on Liver Function After Acute Ischemic Stroke. Neurological Research. 2023 Jan; 45(1): 62-9. doi: 10.1080/01616412.2022.2119724. DOI: https://doi.org/10.1080/01616412.2022.2119724
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
