title: Increased Serum Alkaline Phosphatase as a Predictor of Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients with Atrial Fibrillation and/or Rheumatic Heart Disease.
abstract: OBJECTIVE
  Elevated alkaline phosphatase (ALP) is considered as a marker of liver function in clinical practice. Furthermore, it has been identified that liver function can contribute to hemorrhagic transformation (HT). However, whether ALP levels play a role in HT after stroke remains an open question, especially in cardioembolic stroke patients.
  
  
  METHODS
  We prospectively and consecutively enrolled ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Baseline data including ALP levels within 48 hours after admission were collected. ALP levels were divided into tertiles. The presence of HT, hemorrhagic infarction (HI), parenchymal hematoma (PH), and symptomatic HT was evaluated according to brain magnetic resonance imaging and European-Australasian Acute Stroke Study III definitions. We used logistic regression to examine the associations between ALP levels and risk of HT, HI, PH, and symptomatic HT.
  
  
  RESULTS
  Of the 130 patients (56 male; mean age: 63 years) included finally, 50 (38.5%) developed HT and 13 (10.0%) developed symptomatic HT. ALP levels were not associated with risk of HT, HI, and PH. However, compared with the first ALP tertile, patients in the third tertile were 8.96 times more likely to have symptomatic HT (95% confidence interval: 1.33-60.21; P = .02) after adjusting for age, gender, alanine aminotransferase levels, aspartate aminotransferase levels, antiplatelet therapy, anticoagulation therapy, and thrombolysis therapy.
  
  
  CONCLUSIONS
  Elevated ALP levels may help identify high-risk symptomatic HT in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. However, further studies with larger cohorts are needed to identify our results.
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Liu
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Deren
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Neurology, People's Hospital of Deyang City, Deyang, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Bian
authors.initials: B
authors.lastname: Liu
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Chenchen
authors.initials: C
authors.lastname: Wei
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Simiao
authors.initials: S
authors.lastname: Wu
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
authors.affiliation: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China. Electronic address: wyplmh@hotmail.com.
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D002681:China; D004796:Clinical Enzyme Tests; D004185:Disability Evaluation; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase
keywords: Acute ischemic stroke; alkaline phosphatase; atrial fibrillation; hemorrhagic transformation; rheumatic heart disease