The relationship between serum bilirubin levels andearly neurological improvement in patients withacute ischemic stroke treated with intravenoustissue plasminogen activator

[摘要] Background & Objective: Acute ischemic stroke is defined as the development of sudden neurologicaldeficits resulting from a focal injury due to vascular occlusion in the central nervous system. Intravenoustissue plasminogen activator (t-PA) therapy in these patients is an internationally accepted, evidencebased effective treatment. Previous data suggest that increased serum bilirubin may reflect the intensityof oxidative stress associated with stroke severity. This study aimed to investigate the effect of bilirubinlevels on early neurological improvement after intravenous t-PA treatment and whether bilirubin is adeterminant in in-hospital mortality. Methods: The determinant role of admission bilirubin levels in theseverity of stroke, in-hospital mortality and early neurological improvement after intravenous t-PA wasinvestigated. An independent association of bilirubin with mortality and neurological improvement wereidentified by multivariate logistic regression analysis. Results: A total of 184 ischemic stroke patientswho received intravenous t-PA were included in the study. Serum direct bilirubin, indirect bilirubin,and total bilirubin of patients in the group without early improvement were significantly higher thanthe group with improvement (p= 0.041, p= 0.030, p= 0.026, respectively). Also, in binary logisticregression analysis, total bilirubin was found to be an independent predictor for early neurologicalimprovement (OR 6.257, 95%CI 1.482-26.413, p=0.013).Conclusions: There was a significant relationship between the severity of the stroke and in-hospitalmortality and increased serum bilirubin levels in our study. Again, there was a significant relationshipbetween the lack of early neurological improvement after intravenous t-PA and increased serum bilirubinlevels, and serum direct bilirubin levels were independent predictor of neurological improvement.

[学科分类] 精神健康和精神病学

[关键词] Acute ischemic stroke;tissue plasminogen activator;oxidative stress;bilirubin;NationalInstitutes of Health Stroke Scale;mortality;disability