Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis
Abstract Background This review aims to comprehensively examine the role of bilirubin in predicting severity and adverse clinical outcomes in patients with acute ischemic stroke (AIS). Methods We searched the electronic PubMed, Embase, Scopus, and Web of Science repositories for articles published i...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-025-04168-7 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850201313194803200 |
|---|---|
| author | Ying Zhong Lei Li |
| author_facet | Ying Zhong Lei Li |
| author_sort | Ying Zhong |
| collection | DOAJ |
| description | Abstract Background This review aims to comprehensively examine the role of bilirubin in predicting severity and adverse clinical outcomes in patients with acute ischemic stroke (AIS). Methods We searched the electronic PubMed, Embase, Scopus, and Web of Science repositories for articles published in English available before the 15th of June 2024. The outcomes assessed were stroke severity, haemorrhagic transformation, symptomatic intracranial haemorrhage (sICH), mortality, and poor functional results. Results We analysed data from 13 studies. Our meta-analysis showed that both total bilirubin (RR, 1.10; 95% CI, 1.01–1.19) and direct bilirubin (RR, 1.79; 95% CI, 1.33–2.42) were independently associated with the severity of AIS. Higher quartiles of total bilirubin were associated with an increased risk of haemorrhagic transformation, but without statistical significance (RR, 2.34; 95% CI, 0.90–6.07). In addition, each unit increase in direct (RR, 1.25; 95% CI, 1.09–1.43) and indirect (RR, 1.09; 95% CI, 1.02–1.17) bilirubin levels was significantly associated with a higher risk of haemorrhagic transformation. Moreover, each unit increases in total (RR, 1.08; 95% CI, 1.04–1.12), direct (RR, 1.28; 95% CI, 1.13–1.44), and indirect (RR, 1.10; 95% CI, 1.03–1.18) bilirubin levels was significantly associated with a higher risk of sICH. Data on mortality and poor functional outcomes were insufficient. Conclusion Serum bilirubin levels were positively associated with the severity of AIS. The evidence suggests that bilirubin may be a potential indicator for haemorrhagic transformation and sICH after AIS. |
| format | Article |
| id | doaj-art-5c7251bcb58748d2a43ca41ea1cde2bb |
| institution | OA Journals |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj-art-5c7251bcb58748d2a43ca41ea1cde2bb2025-08-20T02:12:02ZengBMCBMC Neurology1471-23772025-04-0125111410.1186/s12883-025-04168-7Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysisYing Zhong0Lei Li1Geriatrics Department, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou UniversityGeriatrics Department, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou UniversityAbstract Background This review aims to comprehensively examine the role of bilirubin in predicting severity and adverse clinical outcomes in patients with acute ischemic stroke (AIS). Methods We searched the electronic PubMed, Embase, Scopus, and Web of Science repositories for articles published in English available before the 15th of June 2024. The outcomes assessed were stroke severity, haemorrhagic transformation, symptomatic intracranial haemorrhage (sICH), mortality, and poor functional results. Results We analysed data from 13 studies. Our meta-analysis showed that both total bilirubin (RR, 1.10; 95% CI, 1.01–1.19) and direct bilirubin (RR, 1.79; 95% CI, 1.33–2.42) were independently associated with the severity of AIS. Higher quartiles of total bilirubin were associated with an increased risk of haemorrhagic transformation, but without statistical significance (RR, 2.34; 95% CI, 0.90–6.07). In addition, each unit increase in direct (RR, 1.25; 95% CI, 1.09–1.43) and indirect (RR, 1.09; 95% CI, 1.02–1.17) bilirubin levels was significantly associated with a higher risk of haemorrhagic transformation. Moreover, each unit increases in total (RR, 1.08; 95% CI, 1.04–1.12), direct (RR, 1.28; 95% CI, 1.13–1.44), and indirect (RR, 1.10; 95% CI, 1.03–1.18) bilirubin levels was significantly associated with a higher risk of sICH. Data on mortality and poor functional outcomes were insufficient. Conclusion Serum bilirubin levels were positively associated with the severity of AIS. The evidence suggests that bilirubin may be a potential indicator for haemorrhagic transformation and sICH after AIS.https://doi.org/10.1186/s12883-025-04168-7StrokeCerebrovascular accidentLiver functionHaemorrhagic transformation |
| spellingShingle | Ying Zhong Lei Li Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis BMC Neurology Stroke Cerebrovascular accident Liver function Haemorrhagic transformation |
| title | Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis |
| title_full | Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis |
| title_fullStr | Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis |
| title_full_unstemmed | Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis |
| title_short | Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis |
| title_sort | bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke a systematic review and meta analysis |
| topic | Stroke Cerebrovascular accident Liver function Haemorrhagic transformation |
| url | https://doi.org/10.1186/s12883-025-04168-7 |
| work_keys_str_mv | AT yingzhong bilirubinasapredictorofseverityandadverseclinicaloutcomesofacuteischemicstrokeasystematicreviewandmetaanalysis AT leili bilirubinasapredictorofseverityandadverseclinicaloutcomesofacuteischemicstrokeasystematicreviewandmetaanalysis |