scholarly journals Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients

2020 ◽  
Vol 9 (12) ◽  
Author(s):  
Jiancheng Wang ◽  
Xianglin Zhang ◽  
Zhuxian Zhang ◽  
Yuanyuan Zhang ◽  
Jingping Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Cox Proportional Hazards ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Inverse Association ◽  
Baseline Serum ◽  
Hypertensive Patients

Background Data on the association between serum bilirubin and the risk of stroke are limited and inconclusive. We aimed to evaluate the association between serum bilirubin and the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. Methods and Results Our study was a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). A total of 19 906 hypertensive patients were included in the final analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for the risk of first stroke associated with serum bilirubin levels. The median follow‐up period was 4.5 years. When serum total bilirubin was assessed as tertiles, the adjusted HR of first ischemic stroke for participants in tertile 3 (12.9–34.1 μmol/L) was 0.75 (95% CI, 0.59–0.96), compared with participants in tertile 1 (<9.3 μmol/L). When direct bilirubin was assessed as tertiles, a significantly lower risk of first ischemic stroke was also found in participants in tertile 3 (2.5–24.8 μmol/L) (adjusted HR, 0.77; 95% CI, 0.60–0.98), compared with those in tertile 1 (<1.6 μmol/L). However, there was no significant association between serum total bilirubin (tertile 3 versus 1: adjusted HR, 1.45; 95% CI, 0.89–2.35) or direct bilirubin (tertile 3 versus 1: adjusted HR, 1.27; 95% CI, 0.76–2.11) and first hemorrhagic stroke. Conclusions In this sample of Chinese hypertensive patients, there was a significant inverse association between serum total bilirubin or direct bilirubin and the risk of first ischemic stroke.

scholarly journals Nonlinear relationship between serum total bilirubin levels and initial ischemic stroke in patients with non-valvular atrial fibrillation

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096234
Author(s):  
Ying Liu ◽  
Jie Wang ◽  
Wen-zhen Zeng ◽  
Qing-shan Lyu
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Total Bilirubin ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Serum Total Bilirubin ◽  
Hazards Model

Objective This study aimed to examine the relationship between total bilirubin levels and initial ischemic stroke in patients with non-valvular atrial fibrillation. Methods This was a retrospective study. Atrial fibrillation was diagnosed by 24-hour Holter electrocardiography and serum total bilirubin levels were divided into quintiles. Ischemic stroke was diagnosed by symptoms, signs, and a medical image examination. The multivariate Cox proportional hazards model and survival analysis were used to estimate the association of total bilirubin with initial ischemic stroke. Results We studied 316 patients with non-valvular atrial fibrillation. During follow-up, there were 42 (13.29%) first ischemic strokes. After multivariate adjustment, for each 1 µmol/L increase in total bilirubin, the risk of first ischemic stroke increased by 4% (95% confidence interval [CI]: 1.01, 1.07). When using the first quintile as the reference, from the second to fifth quintiles, the risks of first ischemic stroke were 0.52 (95% CI: 0.17, 1.65), 0.23 (95% CI: 0.06, 0.87), 0.92 (95% CI: 0.32, 2.67), and 1.33 (95% CI: 1.09, 4.41), respectively. The optimal cut-off point of total bilirubin for the lowest risk of ischemic stroke was 17.0 µmol/L. Conclusions Total bilirubin levels are nonlinearly associated with initial ischemic stroke in patients with non-valvular atrial fibrillation.

scholarly journals Relationship Between Change in Serum Uric Acid and Ischemic Stroke in Chinese Hypertensive Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Qiu-hong Tan ◽  
Lin Liu ◽  
Yu-qing Huang ◽  
Yu-ling Yu ◽  
Jia-yi Huang ◽  
...  
Keyword(s):  
Uric Acid ◽  
Ischemic Stroke ◽  
Serum Uric Acid ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Elevated Risk ◽  
Rank Test ◽  
Hypertensive Patients ◽  
Cox Proportional Hazards Models ◽  
The Relationship

Background: Limited studies focused on the association between serum uric acid (SUA) change with ischemic stroke, and their results remain controversial. The present study aimed to investigate the relationship between change in SUA with ischemic stroke among hypertensive patients.Method: This was a retrospective cohort study. We recruited adult hypertensive patients who had two consecutive measurements of SUA levels from 2013 to 2014 and reported no history of stroke. Change in SUA was assessed as SUA concentration measured in 2014 minus SUA concentration in 2013. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan–Meier analysis and log-rank test were performed to quantify the difference in cumulative event rate. Additionally, subgroup analysis and interaction tests were conducted to investigate heterogeneity.Results: A total of 4,628 hypertensive patients were included, and 93 cases of ischemic stroke occurred during the mean follow-up time of 3.14 years. Participants were categorized into three groups according to their SUA change tertiles [low (SUA decrease substantially): &lt;-32.6 μmol/L; middle (SUA stable): ≥-32.6 μmol/L, &lt;40.2 μmol/L; high (SUA increase substantially): ≥40.2 μmol/L]. In the fully adjusted model, setting the SUA stable group as reference, participants in the SUA increase substantially group had a significantly elevated risk of ischemic stroke [HR (95% CI), 1.76 (1.01, 3.06), P = 0.0451], but for the SUA decrease substantially group, the hazard effect was insignificant [HR (95% CI), 1.31 (0.75, 2.28), P = 0.3353]. Age played an interactive role in the relationship between SUA change and ischemic stroke. Younger participants (age &lt; 65 years) tended to have a higher risk of ischemic stroke when SUA increase substantially.Conclusion: SUA increase substantially was significantly correlated with an elevated risk of ischemic stroke among patients with hypertension.

scholarly journals Association of Serum Bilirubin with Stroke Severity and Clinical Outcomes

2013 ◽  
Vol 40 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Tian Xu ◽  
Jintao Zhang ◽  
Tan Xu ◽  
Wenqing Liu ◽  
Yan Kong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Direct Bilirubin ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Short Term ◽  
Fourth Quartile

Objective:The aim of the study is to explore the association of serum bilirubin levels with admission severity and short term clinical outcomes among acute ischemic stroke patients.Methods:Data were collected from 2361 acute ischemic stroke patients in four hospitals of Shangdong Province during January 2006 and December 2008. National Institutes of Health Stroke Scale (NIHSS) was used to assess admission and discharge severity. NIHSS≥10 at discharge or in-hospital death was defined as short-term clinical outcomes. Logistic regression and trend test were used to examine the association of serum bilirubin levels with admission severity and short term clinical outcomes.Results:Serum bilirubin levels were significantly and positively associated with admission severity (P for trend <0.05). The age-sex adjusted odds ratios (95% confidential intervals) of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.245 (0.873, 1.777)/1.276 (0.895, 1.818), 1.484 (1.048, 2.102)/1.628 (1.158, 2.289) and 2.869 (2.076, 3.966)/2.765 (1.996, 3.828), respectively, compared with the lowest quartile; the multivariate adjusted odds ratios of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.088(0.711, 1.665)/1.436(0.94, 2.193), 1.328(0.877, 2.011)/1.647(1.092, 2.485) and 2.336(1.579, 3.458)/3.079 (2.049, 4.623), respectively, compared with the lowest quartile. However, no association between serum bilirubin levels and short-term clinical outcomes was observed in our study.Conclusion:Serum bilirubin levels were associated with initial stroke severity closely. Nevertheless, there is no significant relationship between serum bilirubin levels and short-term clinical outcomes among acute ischemic stroke patients.

scholarly journals Associations of Serum Total Bilirubin with Survival Outcomes in Patients with Cancer Cachexia: A Retrospective, Multicenter Cohort Study

2021 ◽  
Author(s):  
Xiang-Rui Li ◽  
Qi Zhang ◽  
Kang-Ping Zhang ◽  
Xi Zhang ◽  
Guo-Tian Ruan ◽  
...  
Keyword(s):  
Cancer Cachexia ◽  
Proportional Hazards ◽  
Total Bilirubin ◽  
High Serum ◽  
Cox Proportional Hazards ◽  
Serum Total Bilirubin ◽  
Research Database ◽  
Multicenter Cohort Study ◽  
Patients With Cancer ◽  
All Cause Mortality

Abstract Background: Cancer cachexia is a systemic paraneoplastic phenomenon involving multiple organs, including the liver. Total bilirubin (TBIL) is an easily obtained blood biomarker that reflects liver homeostasis. This work evaluated the prognostic value of serum TBIL in patients with cancer cachexia.Methods: This study included 2,282 patients from a multicenter research database who were diagnosed with cancer cachexia between June 2012 and December 2019. The hazard ratio (HR) for all-cause mortality was analyzed using Cox proportional hazards regression models. The association of serum TBIL with all-cause mortality was modeled with restricted cubic splines. The optimal cutoff value for TBIL was calculated with maximally selected rank statistics.Results: Among the participants, there were 1,327 (58.2%) males and 955 (41.8%) females. The mean patient age was 60.4±1.5 years. The 12-month all-cause mortality rate for patients with cancer cachexia was 29.5% (95% CI: 27.6%-31.3%), resulting in a rate of 209.58 events per 1000 patient-years. An inverted L-shaped association between TBIL and all-cause mortality was observed. The cutoff point for TBIL for the prediction of the time to mortality was < 21.7 µmol/L. A high TBIL level but not the direct bilirubin (DBIL) or indirect bilirubin (IBIL) level was identified as an independent prognostic factor (HR, 1.60, 95% CI, 1.32-1.93). For patients with digestive system tumors, a high serum TBIL level (≥21.7 µmol/L) was significantly associated with mortality. Conclusion: High TBIL levels are associated with increased all-cause mortality in patients and might be a promising prognostic indicator in patients with cancer cachexia.

scholarly journals Association Between the Change in Total Bilirubin and Risk of Bleeding Among Patients With Nonvalvular Atrial Fibrillation Taking Dabigatran

2020 ◽  
Vol 26 ◽  
pp. 107602962091080
Author(s):  
Yurong Xiong ◽  
Lihua Hu ◽  
Wei Zhou ◽  
Minghui Li ◽  
Tao Wang ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Total Bilirubin ◽  
Cox Proportional Hazards ◽  
Serum Total Bilirubin ◽  
Bleeding Events ◽  
Nonvalvular Atrial Fibrillation ◽  
Risk Of Bleeding ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression

There is still a lack of effective biomarkers for the prediction of the risk of bleeding events among patients with nonvalvular atrial fibrillation (NVAF) taking dabigatran. This study aimed to investigate the association between change in total bilirubin (CTBIL) and risk of bleeding among patients with NVAF taking dabigatran. The CTBIL was the difference in serum total bilirubin at out of follow-up from baseline serum total bilirubin. A total of 486 patients with NVAF treated with dabigatran (110 mg twice daily) were recruited from 12 centers in China from February 2015 to December 2017. All patients were followed for 3 months. Cox proportional hazards regression analysis was used to evaluate the association between the CTBIL and bleeding. Moreover, a Cox proportional hazards regression with cubic spline functions and smooth curve fitting (the penalized spline method) and 2 piecewise Cox proportional hazards models were used to address the nonlinearity between CTBIL and bleeding. The mean (SD) follow-up duration was 81.2 (20.2) days. In all, 67 patients experienced bleeding events. A U-shaped association was observed between the CTBIL and bleeding, with increased hazard ratios (HRs) in relation to either low or high CTBIL levels. For CTBIL <6.63 µmol/L, the HR (95% confidence interval [CI]) was 0.90 (0.84-0.96), and for CTBIL ≥6.63 µmol/L, the HR (95% CI) was 1.35 (1.14-1.60). Our findings showed a U-shaped relationship between CTBIL and bleeding. Both low and high levels of CTBIL were associated with a higher risk of bleeding.

scholarly journals CD14/-159 and TNFα/-308 Promoter Polymorphisms are not associated with Development of Idiopathic Neonatal Hepatitis among Filipinos

2017 ◽  
Vol 51 (3) ◽  
Author(s):  
Florence Giannina F. San Juan ◽  
Annavi Marie G. Villanueva ◽  
Germana Emerita V. Gregorio ◽  
Catherine Lynn T. Silao
Keyword(s):  
Alkaline Phosphatase ◽  
Total Bilirubin ◽  
Direct Sequencing ◽  
Direct Bilirubin ◽  
Neonatal Hepatitis ◽  
Serum Total Bilirubin ◽  
Promoter Polymorphisms ◽  
Baseline Serum ◽  
Significant Difference ◽  
Idiopathic Neonatal Hepatitis

Objective. To determine if the CD14/-159 and the TNFα/-308 single nucleotide polymorphisms (SNPs) are associated with the development of Idiopathic Neonatal Hepatitis (INH) in Filipino children. Methods. Genomic DNA from 33 patients diagnosed with INH and 33 age- and sex-matched controls, children without any liver disease, were recruited. Baseline serum total bilirubin (TB), direct bilirubin (DB), and alkaline phosphatase (ALP) of the patients were obtained from their medical records. Genotypes for CD14/159 and TNFα/-308 were determined via PCR and direct sequencing. Results. No significant difference was seen between the frequency of the CD14/-159 T allele (p=0.86) nor the TNFα/-308 A allele (p=0.62) between INH patients and controls. There was also no significant difference between the genotypic distribution of the INH and control populations for both CD14/-159 (p=0.54) and TNFα/-308 (p=0.62). There were also no significant differences noted between the different genotypes of CD14/159 and TNFα/-308 and levels of alkaline phosphatase (p=0.65, p=0.91), total bilirubin (p=0.89, p=0.75), and direct bilirubin (p=0.93, p=0.68). Conclusion. In this preliminary study, CD14/-159 and TNFα/-308 showed no association with the development of INH among Filipinos.

scholarly journals Association between Plasma Homocysteine Concentrations and the First Ischemic Stroke in Hypertensive Patients with Obstructive Sleep Apnea: A 7-Year Retrospective Cohort Study from China

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Nanfang Li ◽  
Xintian Cai ◽  
Qing Zhu ◽  
Xiaoguang Yao ◽  
Mengyue Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Proportional Hazards ◽  
Additive Model ◽  
Cox Proportional Hazards ◽  
Plasma Homocysteine ◽  
Nonlinear Relationship ◽  
Hypertensive Patients ◽  
Obstructive Sleep

Purpose. This study was aimed at investigating the association between baseline plasma homocysteine (Hcy) concentrations and the risk of the first ischemic stroke (IS) and at investigating any possible influential modifying factors in hypertensive patients with obstructive sleep apnea (OSA). Methods. Cox proportional hazards regression was employed to investigate the relationship between plasma Hcy concentration and the first IS. A generalized additive model was applied to determine the nonlinear relationship. In addition, we conducted subgroup analysis. Results. A total of 2350 hypertensive patients with OSA without a history of IS were enrolled in this study. At a median follow-up of 7.15 years, we identified 93 cases of the first IS. After adjusting for potential confounding, the findings revealed that plasma Hcy concentration was strongly and positively associated with the occurrence of the first IS (per SD increment; HR = 1.37 , 95% CI: 1.30-1.44). A nonlinear relationship was found between plasma Hcy concentration and the risk of developing the first IS with inflection points for plasma Hcy of 5 μmol/L. In stratified analysis, a greater positive correlation was found between baseline plasma Hcy concentrations and new-onset IS in patients with DBP ≥ 90   mmHg (per SD increment; HR = 1.48 , 95% CI: 1.33-1.65 vs. <90 mmHg: HR = 1.20 , 95% CI: 1.02-1.42; P ‐ interaction = 0.04 ) and BMI ≥ 24 and <28 kg/m2 (per SD increment; HR = 1.46 , 95% CI: 1.26-1.70 vs. <24 kg/m2: HR = 1.13 , 95% CI: 0.95-1.33 vs. ≥28 kg/m2: HR = 1.46 , 95% CI: 1.25-1.70; P ‐ interaction = 0.03 ). Conclusion. Elevated plasma Hcy concentrations are independently associated with the risk of the first IS in hypertensive patients with OSA. Plasma Hcy concentrations ≥ 5   μ mol / L surely increased the risk of the first IS in hypertensive patients with OSA.

Abstract 73: Sex Hormone Binding Globulin: A Novel Hormonal Biomarker for Ischemic Stroke Risk?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tracy E Madsen ◽  
Xi Luo ◽  
Mengna Huang ◽  
Ki Park ◽  
Marcia L Stefanick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Sex Hormone ◽  
Sex Hormone Binding Globulin ◽  
Inverse Association ◽  
Hormone Binding

Introduction: Sex hormone binding globulin (SHBG) is a sex-steroid transporter previously linked to cardiometabolic outcomes such as diabetes (DM) and coronary heart disease and their risk factors. It remains uncertain whether SHBG also affects stroke risk, particularly in women. We investigated whether SHBG affects risk of incident ischemic stroke (IS) among women in the Women’s Health Initiative (WHI). Methods: The WHI includes randomized trials and an observational cohort of 161808 postmenopausal women enrolled at 40 sites across the U.S. from 1993 - 1998. We identified 13,192 participants free of prevalent stroke at baseline who were included in one of eleven ancillary studies with serum SHBG. Incident IS events through 2017 were identified via physician adjudication of medical records. We used Cox proportional hazards regression to assess IS risk across quartiles of SHBG levels (Q1 - Q4), first adjusted for demographics, body mass index (BMI), hypertension, alcohol use, and smoking status (Model 1). History of DM was added to remove indirect effects through DM (Model 2), followed by the addition of reproductive risk factors and physical activity (Model 3). Results: Of 13,192 participants (mean age 62.5 years, 67.4% non-Hispanic white, 18.5% black, 5.0% Asian, 7.6% Hispanic), 877 IS events were confirmed during follow-up. Compared to the highest SHBG quartile (referent), women in the lowest quartile had a higher risk of IS in all three models (Model 1: HR 1.51, 95%CI 1.23 - 1.86, Model 2: HR 1.46, 95%CI 1.18 - 1.80, Model 3: HR: 1.38, 95%CI 1.07 - 1.76, trend tests p <0.05 for all). Women in the middle quartiles (Q2, Q3) also had increased IS risk compared with those in the highest SHBG quartile (Table). Conclusions: In this prospective cohort of post-menopausal women, there was a statistically significant inverse association between SHBG levels and IS risk, which supports the notion that SHBG could be used as a risk stratification tool for predicting IS in women.

scholarly journals Total adiponectin is associated with incident cardiovascular and renal events in treated hypertensive patients: subanalysis of the ATTEMPT-CVD randomized trial

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Shokei Kim-Mitsuyama ◽  
Hirofumi Soejima ◽  
Osamu Yasuda ◽  
Koichi Node ◽  
Hideaki Jinnouchi ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Randomized Study ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Baseline Serum ◽  
Hypertensive Patients ◽  
Hmw Adiponectin ◽  
Kaplan Meier ◽  
Total Adiponectin ◽  
Significant Difference

Abstract The predictive value of serum adiponectin for hypertensive cardiovascular outcomes is unknown. This study was performed to investigate the association of adiponectin with incident cardiovascular and renal events (CV events) in hypertensive patients. We performed post-hoc analysis on 1,228 hypertensive patients enrolled in the ATTEMPT-CVD study, a prospective randomized study comparing the effects of two antihypertensive therapies. The participants were divided into quartiles of baseline serum total adiponectin or high molecular weight (HMW) adiponectin. Multivariable Cox proportional hazards analysis was performed to determine the prognostic factors associated with CV events. Kaplan-Meier analysis for CV events by quartiles of baseline total adiponectin showed that patients in the highest total adiponectin quartile (Q4) had more CV events (P = 0.0135). On the other hand, no significant difference was noted regarding the incidence of CV events among patients stratified by HMW adiponectin quartile (P = 0.2551). Even after adjustment for potential confounders, the highest total adiponectin quartile (Q4) remained independently associated with incident CV events in hypertensive patients (HR = 1.949: 95%CI 1.051–3.612; P = 0.0341). These results showed that total adiponectin, but not HMW adiponectin, was independently associated with the incidence of CV events in treated hypertensive patients, thereby highlighting total adiponectin as a valuable predictor for hypertensive cardiovascular outcomes.

scholarly journals Clinical Significance of Serum Bilirubin in the Diagnosis of Atypical Acute Appendicitis

2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Shunxin Hao ◽  
Lisha Zhao
Keyword(s):  
Liver Function ◽  
Acute Appendicitis ◽  
Clinical Significance ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Serum Bilirubin Level ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin

Objective: To investigate the significance of serum bilirubin in the diagnosis of atypical acute appendicitis. Methods: perform a retrospective analysis of 120 patients with atypical acute appendicitis diagnosed in our hospital from July 2012 to July 2016. All patients underwent routine liver function tests before surgery. Results: 83 patients were confirmed by surgery as acute appendicitis, of which 68 patients had elevated serum total bilirubin and direct bilirubin, and 15 patients were normal; 37 patients were confirmed by surgery as non-acute appendicitis, of which 7 patients had elevated serum total bilirubin and direct bilirubin, and 30 patients were normal. Conclusion: The increase of serum bilirubin level has certain clinical significance for the diagnosis of atypical acute appendicitis.

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