title: Liver Function Indicators Performed Better to Eliminate Cardioembolic Stroke than to Identify It from Stroke Subtypes.
abstract: BACKGROUND
  Identifying the etiology of ischemic stroke is essential to acute management and secondary prevention. The value of liver function indicators in differentiating stroke subtypes remains to be evaluated.
  
  
  METHODS
  A total of 1333 acute ischemic stroke patients were included. Liver function indicators collected within 24 hours from stroke onset, including alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), and bilirubin (BILI), were collapsed into quartiles (Q) and also dichotomized by Q1. Multivariate regression analysis was conducted to identify the independent association between liver function indicators and cardioembolic stroke (SCE). Area under the curve (AUC) of receiver operating characteristic analysis was conducted, and sensitivity (Sen), specificity (Spe), positive prospective value (PPV), and negative prospective value (NPV) were determined to evaluate the predictive value of liver function indicators for SCE.
  
  
  RESULTS
  AST, GGT, and BILI were associated with SCE. After adjustment, only AST was related to SCE independently. The incidence of SCE in the Q1 of AST, GGT, and BILI, particularly in the Q1 of AST, was quite low. The ability of AST, GGT, and BILI to identify SCE was poor, with low AUC, Sen, and PPV. The value of AST, GGT, and BILI in eliminating SCE from stroke subtypes was good, with high Spe and moderate NPV, and was enhanced after combining each liver function indicator.
  
  
  CONCLUSIONS
  Results of present study demonstrated that AST, GGT, and BILI, particularly AST, had a potential to eliminate SCE from stroke subtypes, and the ability of eliminating SCE would be strengthened after combining each liver function indicator together.
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors: Ge
authors: G
authors: Tan
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors: Ruozhen
authors: R
authors: Yuan
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors: Zilong
authors: Z
authors: Hao
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors: Chunyan
authors: C
authors: Lei
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors: Yao
authors: Y
authors: Xiong
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors: Mangmang
authors: M
authors: Xu
authors: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China. Electronic address: wyplmh@hotmail.com.
authors: Ming
authors: M
authors: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001219:Aspartate Aminotransferases; D001663:Bilirubin / Q000378:metabolism; D002545:Brain Ischemia / Q000150:complications*; D002681:China; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism* / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult; D005723:gamma-Glutamyltransferase
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: Ischemic stroke; TOAST classification; liver function indicators; stroke subtypes