title: Changes of liver enzymes and bilirubin during ischemic stroke: mechanisms and possible significance.
abstract: BACKGROUND
  Small changes of bilirubin and liver enzymes are often detected during the acute phase of stroke, but their origin and significance are still poorly understood.
  
  
  METHODS
  On days 0, 3, 7, and 14 after admission, 180 patients with ischemic stroke underwent serial determinations of bilirubin, GOT, GPT, γGT, alkaline phosphatase, C-reactive protein (CRP) and complete blood count. On days 0 and 7 common bile duct diameter was measured by ultrasound, and on day 3 cerebral infarct volume (IV) was calculated from CT scan slices.
  
  
  RESULTS
  During the first week GOT, GPT, γGT (P < 0.001) and CRP (P = 0.03) increased with subsequent plateau, while significant decrements (P < 0.001) concerned unconjugated bilirubin, erythrocytes and haemoglobin. Alkaline phosphatase, direct bilirubin and common bile duct diameter remained stable. IV correlated with CRP, leukocytes, GOT, γGT (r > 0.3, P < 0.001 for all) and direct bilirubin (r = 0.23, P = 0.008). In multivariate analysis only CRP and GOT remained independently associated with IV (P < =0.001). The correlation of IV with GOT increased progressively from admission to day 14. GOT independently correlated with GPT which, in turn, correlated with γGT. γGT was also highly correlated with leukocytes. Unconjugated bilirubin correlated with haemoglobin, which was inversely correlated with CRP.
  
  
  CONCLUSIONS
  The changes of bilirubin and liver enzymes during ischemic stroke reflect two phenomena, which are both related to IV: 1) inflammation, with consequent increment of CRP, leukocytes and γGT, and decrease of haemoglobin and unconjugated bilirubin and 2) an unknown signal, independent from inflammation, leading to increasing GOT and GPT levels.
authors.affiliation: Stroke Unit - Department of Internal Medicine, Aging and Nephrological Diseases, S, Orsola-Malpighi Hospital, Via Albertoni, 15, Bologna 40138, Italy. antonio.muscari@unibo.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Muscari
authors.forename: Andrea
authors.initials: A
authors.lastname: Collini
authors.forename: Elisa
authors.initials: E
authors.lastname: Fabbri
authors.forename: Marco
authors.initials: M
authors.lastname: Giovagnoli
authors.forename: Chiara
authors.initials: C
authors.lastname: Napoli
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.forename: Luca
authors.initials: L
authors.lastname: Vizioli
authors.forename: Andrea
authors.initials: A
authors.lastname: Bonfiglioli
authors.forename: Donatella
authors.initials: D
authors.lastname: Magalotti
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Puddu
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood*; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000201:enzymology; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D009460:Neurologic Examination; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000201:enzymology; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D001663:Bilirubin