Abstract
BackgroundBile acids (BAs) not only play an important role in lipid metabolism and atherosclerosis but also have antiapoptotic and neuroprotective effects. However, few studies have focused on the relationship of the total bile acid (TBA) levels with the severity and prognosis of acute ischemic stroke (AIS).ObjectivesThe aim of this study was to investigate the potential associations of the fasting serum TBA levels on admission with the stroke severity, in-hospital complication incidence and 3 -month all-cause mortality in patients with AIS.MethodsA total of 777 consecutive AIS patients were enrolled in this study and were divided into four groups according to the quartiles of the serum TBA levels on admission. Univariate and multivariate logistic regression analyses were used to explore the relationship between the fasting TBA levels and the stroke severity, in-hospital complications, and 3-month mortality in AIS patients.ResultsPatients in group Q3 had the lowest risk of severe AIS (NIHSS > 10) regardless of the adjustments for confounders (P < 0.05). During hospitalization, 115 patients (14.8%) had stroke progression (NIHSS score increased by ≥ 2), and 222 patients (28.6%) developed at least one complication, with no significant difference among the four groups (P > 0.05). There was no significant difference in the incidence of pneumonia, urinary tract infection (UTI), hemorrhagic transformation (HT), gastrointestinal bleeding (GIB), seizures or renal insufficiency (RI) among the four groups (P > 0.05). A total of 114 patients (14.7%) died from various causes (including in-hospital deaths) at the 3-month follow-up, including 42 (21.3%), 26 (13.3%), 19 (9.9%) and 27 (13.9%) patients in groups Q1, Q2, Q3 and Q4 respectively, with significant differences (P = 0.013). After adjusting for confounding factors, the risk of death decreased (P -trend < 0.05) in groups Q2, Q3, and Q4 when compared with group Q1, and the OR values were 0.36 (0.16-0.80), 0.30 (0.13-0.70), and 0.29 (0.13-0.65), respectively.ConclusionsTBA levels were inversely associated with the 3-month mortality of AIS patients but were not significantly associated with the severity of stroke or the incidence of complications.
Highlights
As the population ages, stroke has become the second leading cause of death(11.6% [10.8–12.2] of the total deaths in 2019) worldwide after ischemic heart disease [1] and is associated with a high rate of disability and recurrence, which brings a great burden to society and families, especially in low- and middle-income countries [1, 2]
total bile acid (TBA) levels were inversely associated with the 3-month mortality of acute ischemic stroke (AIS) patients but were not significantly associated with the severity of stroke or the incidence of complications
The diagnosis of AIS was made by two or more neurologists after admission to our hospital based on the patient’s medical history, clinical presentation, and brain computed tomography (CT) or magnetic resonance imaging (MRI) manifestations, according to World Health Organization (WHO) standards as follows: the development of a sudden focal or a complete neurological deficit, a neurological deficit lasting more than 24 h, exclusion of brain dysfunction caused by other nonvascular factors, and a diagnosis based on brain CT or MRI
Summary
Stroke has become the second leading cause of death(11.6% [10.8–12.2] of the total deaths in 2019) worldwide after ischemic heart disease [1] and is associated with a high rate of disability and recurrence, which brings a great burden to society and families, especially in low- and middle-income countries [1, 2]. In 2019, acute ischemic stroke (AIS) was reported to account for 62.4% of all stroke events globally [1]. Primary intracerebral hemorrhage (PICH) accounted for approximately 27.9% of strokes, and subarachnoid hemorrhage (SAH) accounted for 9.7% of strokes [1]. Treatments such as early intravenous thrombolysis and endovascular treatment can allow the occluded blood vessels to be recanalized leading to blood reperfusion, which may reduce the infarct volume and effectively improve the overall prognosis of stroke patients. Few studies have focused on the relationship of the total bile acid (TBA) levels with the severity and prognosis of acute ischemic stroke (AIS)
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