Changes of liver enzymes and bilirubin during ischemic stroke: mechanisms and possible significance.

Luca Vizioli,Elisa Fabbri,Antonio Muscari,Marco Zoli,Marco Giovagnoli,Andrea Collini,Valentina Rossi,Chiara Napoli,Donatella Magalotti,Andrea Bonfiglioli,Giovanni M Puddu

doi:10.1186/1471-2377-14-122

Luca Vizioli, Elisa Fabbri + Show 9 more

Open Access

https://doi.org/10.1186/1471-2377-14-122

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Abstract

BackgroundSmall changes of bilirubin and liver enzymes are often detected during the acute phase of stroke, but their origin and significance are still poorly understood.MethodsOn days 0, 3, 7, and 14 after admission, 180 patients with ischemic stroke underwent serial determinations of bilirubin, GOT, GPT, γGT, alkaline phosphatase, C-reactive protein (CRP) and complete blood count. On days 0 and 7 common bile duct diameter was measured by ultrasound, and on day 3 cerebral infarct volume (IV) was calculated from CT scan slices.ResultsDuring the first week GOT, GPT, γGT (P < 0.001) and CRP (P = 0.03) increased with subsequent plateau, while significant decrements (P < 0.001) concerned unconjugated bilirubin, erythrocytes and haemoglobin. Alkaline phosphatase, direct bilirubin and common bile duct diameter remained stable. IV correlated with CRP, leukocytes, GOT, γGT (r > 0.3, P < 0.001 for all) and direct bilirubin (r = 0.23, P = 0.008). In multivariate analysis only CRP and GOT remained independently associated with IV (P < =0.001). The correlation of IV with GOT increased progressively from admission to day 14. GOT independently correlated with GPT which, in turn, correlated with γGT. γGT was also highly correlated with leukocytes. Unconjugated bilirubin correlated with haemoglobin, which was inversely correlated with CRP.ConclusionsThe changes of bilirubin and liver enzymes during ischemic stroke reflect two phenomena, which are both related to IV: 1) inflammation, with consequent increment of CRP, leukocytes and γGT, and decrease of haemoglobin and unconjugated bilirubin and 2) an unknown signal, independent from inflammation, leading to increasing GOT and GPT levels.

Highlights

Small changes of bilirubin and liver enzymes are often detected during the acute phase of stroke, but their origin and significance are still poorly understood
This study has shown that the small but significant changes of liver enzymes and bilirubin occurring during the early phase of ischemic stroke are attributable, directly or indirectly, to the size of cerebral infarct
This study suggests that the liver participates to a variable extent in the acute phase of ischemic stroke, producing enzymes in response to signals coming from cerebral infarct and proportional to its size

Summary

Introduction

Small changes of bilirubin and liver enzymes are often detected during the acute phase of stroke, but their origin and significance are still poorly understood. Some previous studies have reported an increment of bilirubin levels during ischemic or haemorrhagic stroke, and their association with the severity of symptoms [1,2]. These results (concerning in particular direct bilirubin [1]), could be related to the anti-oxidant action of this molecule, which might counteract the oxidative processes contributing to cerebral damage during the acute phase [3,4]. Γ-GT would have a long term predictive significance for new cases of stroke [7,8], which could be due to its relation to alcohol, which in turn is a recognized risk factor for stroke [9,10]

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