Skip to main content

Advertisement

SpringerLink
Log in

Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Whether subclinical change of liver function is associated with outcome of spontaneous intracerebral hemorrhage remains to be an open question. A total of 639 patients of spontaneous intracerebral hemorrhage within 7 days from stroke onset were finally enrolled. Liver function indicators, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin (BIL), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), albumin (ALB), and international normalized ratio (INR), were collected and collapsed into quartiles. The main outcomes were 30-day death, 90-day death, and 90-day poor outcome (modified Rankin Scale score of 3–6). Two adjusted model, Model 1 and Model 2 (Model 1 plus GCS score), were established to identify independent association between liver function indicators and ICH outcomes. The mortality rate was 19.9 % (127/639) at 30 days and 21.3 % (136/639) at 90 days. Rate of 90-day poor outcome was 51.5 % (329/639). Among liver function indicators, AST and ALP were associated with all the three outcomes, which did not alter significantly when adjusted by Model 1. After adjusted by Model 2, ALP was still associated with outcomes. Association between AST and outcomes was, however, weakened significantly by GCS score. In conclusions, among liver function indicators, AST and ALP were associated with outcomes after spontaneous intracerebral hemorrhage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Qureshi AI, Mendelow AD, Hanley DF (2009) Intracerebral haemorrhage. Lancet 373:1632–1644

    Article  PubMed  PubMed Central  Google Scholar 

  2. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr et al (2010) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 41:2108–2129

    Article  PubMed  PubMed Central  Google Scholar 

  3. Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L et al (2014) European stroke organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 9:840–855

    Article  PubMed  Google Scholar 

  4. Hoekstra LT, de Graaf W, Nibourg GA, Heger M, Bennink RJ, Stieger B et al (2013) Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg 257:27–36

    Article  PubMed  Google Scholar 

  5. Ebrahimkhani MR, Neiman JA, Raredon MS, Hughes DJ, Griffith LG (2014) Bioreactor technologies to support liver function in vitro. Adv Drug Deliv Rev 69–70:132–157

    Article  PubMed  Google Scholar 

  6. Fujii Y, Takeuchi S, Tanaka R, Koike T, Sasaki O, Minakawa T (1994) Liver dysfunction in spontaneous intracerebral hemorrhage. Neurosurgery 35:592–596

    Article  CAS  PubMed  Google Scholar 

  7. Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O (1994) Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 80:51–57

    Article  CAS  PubMed  Google Scholar 

  8. Niizuma H, Shimizu Y, Nakasato N, Jokura H, Suzuki J (1988) Influence of liver dysfunction on volume of putaminal hemorrhage. Stroke 19:987–990

    Article  CAS  PubMed  Google Scholar 

  9. Huang HH, Lin HH, Shih YL, Chen PJ, Chang WK, Chu HC et al (2008) Spontaneous intracranial hemorrhage in cirrhotic patients. Clin Neurol Neurosurg 110:253–258

    Article  PubMed  Google Scholar 

  10. Boudouresques G, Hauw JJ, Meininger V, Escourolle R, Pertuiset B, Buge A et al (1980) Hepatic cirrhosis and intracranial hemorrhage: significance of the association in 53 pathological cases. Ann Neurol 8:204–205

    Article  CAS  PubMed  Google Scholar 

  11. Niizuma H, Suzuki J, Yonemitsu T, Otsuki T (1988) Spontaneous intracerebral hemorrhage and liver dysfunction. Stroke 19:852–856

    Article  CAS  PubMed  Google Scholar 

  12. Ryu WS, Lee SH, Kim CK, Kim BJ, Yoon BW (2010) Increased serum alkaline phosphatase as a predictor of long-term mortality after stroke. Neurology 75:1995–2002

    Article  CAS  PubMed  Google Scholar 

  13. Ruttmann E, Brant LJ, Concin H, Diem G, Rapp K, Ulmer H (2005) Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation 112:2130–2137

    Article  CAS  PubMed  Google Scholar 

  14. Kim KH (2009) Predictors of 30-day mortality and 90-day functional recovery after primary intracerebral hemorrhage: hospital based multivariate analysis in 585 patients. J Korean Neurosurg Soc 45:341–349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Perlstein TS, Pande RL, Creager MA, Weuve J, Beckman JA (2008) Serum total bilirubin level, prevalent stroke, and stroke outcomes: NHANES 1999–2004. Am J Med 121(781–788):e781

    Article  Google Scholar 

  16. Fang HY, Lin CY, Ko WJ (2005) Hematology and coagulation parameters predict outcome in Taiwanese patients with spontaneous intracerebral hemorrhage. Eur J Neurol 12:226–232

    Article  PubMed  Google Scholar 

  17. Ryu WS, Lee SH, Kim CK, Kim BJ, Kwon HM, Yoon BW (2014) High serum alkaline phosphatase in relation to cerebral small vessel disease. Atherosclerosis 232:313–318

    Article  CAS  PubMed  Google Scholar 

  18. Kim J, Song TJ, Song D, Lee HS, Nam CM, Nam HS et al (2013) Serum alkaline phosphatase and phosphate in cerebral atherosclerosis and functional outcomes after cerebral infarction. Stroke 44:3547–3549

    Article  CAS  PubMed  Google Scholar 

  19. Tonelli M, Curhan G, Pfeffer M, Sacks F, Thadhani R, Melamed ML et al (2009) Relation between alkaline phosphatase, serum phosphate, and all-cause or cardiovascular mortality. Circulation 120:1784–1792

    Article  CAS  PubMed  Google Scholar 

  20. Loftspring MC, Johnson HL, Feng R, Johnson AJ, Clark JF (2011) Unconjugated bilirubin contributes to early inflammation and edema after intracerebral hemorrhage. J Cereb Blood Flow Metab 31:1133–1142

    Article  CAS  PubMed  Google Scholar 

  21. Stocker R, Yamamoto Y, McDonagh AF, Glazer AN, Ames BN (1987) Bilirubin is an antioxidant of possible physiological importance. Science 235:1043–1046

    Article  CAS  PubMed  Google Scholar 

  22. Senn R, Elkind MS, Montaner J, Christ-Crain M, Katan M (2014) Potential role of blood biomarkers in the management of nontraumatic intracerebral hemorrhage. Cerebrovasc Dis 38:395–409

    Article  CAS  PubMed  Google Scholar 

  23. Campos F, Sobrino T, Ramos-Cabrer P, Castellanos M, Blanco M, Rodriguez-Yanez M et al (2011) High blood glutamate oxaloacetate transaminase levels are associated with good functional outcome in acute ischemic stroke. J Cereb Blood Flow Metab 31:1387–1393

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Chakraborty B, Vishnoi G, Goswami B, Gowda SH, Chowdhury D, Agarwal S (2013) Lipoprotein(a), ferritin, and albumin in acute phase reaction predicts severity and mortality of acute ischemic stroke in North Indian Patients. J Stroke Cerebrovasc Dis 22:e159–e167

    Article  PubMed  Google Scholar 

  25. Turhan N, Saracgil N, Oztop P, Bayramoglu M (2006) Serum albumin and comorbidity relative to rehabilitation outcome in geriatric stroke, and possible links with stroke etiology. Int J Rehabil Res 29:81–85

    Article  PubMed  Google Scholar 

  26. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    Article  PubMed  Google Scholar 

  27. Falcone GJ, Biffi A, Brouwers HB, Anderson CD, Battey TW, Ayres AM et al (2013) Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage. JAMA Neurol 70:988–994

    Article  PubMed  Google Scholar 

  28. Zis P, Leivadeas P, Michas D, Kravaritis D, Angelidakis P, Tavernarakis A (2014) Predicting 30-day case fatality of primary inoperable intracerebral hemorrhage based on findings at the emergency department. J Stroke Cerebrovasc Dis 23:1928–1933

    Article  PubMed  Google Scholar 

  29. Sousa LD, Zorrilla JP, Latini MF, Alvarez Abut P, Ayala M, Romano LM et al (2011) Is the international normalised ratio a prognostic factor of mortality in intracerebral haemorrhage? Neurologia 26:528–532

    Article  CAS  PubMed  Google Scholar 

  30. Mansouri B, Heidari K, Asadollahi S, Nazari M, Assarzadegan F, Amini A (2013) Mortality and functional disability after spontaneous intracranial hemorrhage: the predictive impact of overall admission factors. Neurol Sci 34:1933–1939

    Article  PubMed  Google Scholar 

  31. Campos F, Rodriguez-Yanez M, Castellanos M, Arias S, Perez-Mato M, Sobrino T et al (2011) Blood levels of glutamate oxaloacetate transaminase are more strongly associated with good outcome in acute ischaemic stroke than glutamate pyruvate transaminase levels. Clin Sci (Lond) 121:11–17

    Article  CAS  Google Scholar 

  32. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891–897

    Article  PubMed  Google Scholar 

  33. Gurbuzer N, Gozke E (2014) Gamma-glutamyl transferase levels in patients with acute ischemic stroke. Cardiovasc Psychiatry Neurol 2014:170626

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pompella A, Emdin M, Passino C, Paolicchi A (2004) The significance of serum gamma-glutamyltransferase in cardiovascular diseases. Clin Chem Lab Med 42:1085–1091

    Article  CAS  PubMed  Google Scholar 

  35. Ginsberg MD, Palesch YY, Hill MD, Martin RH, Moy CS, Barsan WG et al (2013) High-dose albumin treatment for acute ischaemic stroke (ALIAS) Part 2: a randomised, double-blind, phase 3, placebo-controlled trial. Lancet Neurol 12:1049–1058

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was supported by the National Key Technology R&D Program for the 12th Five-Year Plan of People’s Republic of China (2011BAI08B05).

Author information

Authors and Affiliations

  1. Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, People’s Republic of China

    Ge Tan, Zilong Hao, Chunyan Lei, Yanchao Chen, Ruozhen Yuan, Mangmang Xu & Ming Liu

Authors
  1. Ge Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zilong Hao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chunyan Lei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanchao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ruozhen Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mangmang Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ming Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ming Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, G., Hao, Z., Lei, C. et al. Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage. Neurol Sci 37, 1693–1700 (2016). https://doi.org/10.1007/s10072-016-2656-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-016-2656-0

Keywords

Search

Navigation