title: Association of serum bilirubin with stroke severity and clinical outcomes.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Xu
authors.forename: Jintao
authors.initials: J
authors.lastname: Zhang
authors.forename: Tan
authors.initials: T
authors.lastname: Xu
authors.forename: Wenqing
authors.initials: W
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Kong
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood* / Q000473:pathology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
chemical_list: D001663:Bilirubin