Higher baseline serum bilirubin levels are associated with increased risk of early neurological deterioration in women with acute ischemic stroke

 So you described a problem, offered NO solution. FUCKING USELESS!

Higher baseline serum bilirubin levels are associated with increased risk of early neurological deterioration in women with acute ischemic stroke

Meng Sun^†Yingfeng Weng^†Jiwei ChengGuoyi Li^*Qian Xiao^*

• Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Background and objectives: Early neurological deterioration (END) occurs in up to one-third of patients with acute ischemic stroke (AIS) and associated with poor outcome. The role of serum bilirubin in END remains controversial. This study aims to investigate the association of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) with END.(Totally wrong objective! It should have been; How to prevent this early neurological deterioration.)

Methods: This study was a cross-sectional retrospective study with 344 AIS patients enrolled. We retrospectively reviewed consecutive AIS patients with END through a medical record retrieval system and enrolled patients as control randomly from the AIS patients without END at the same period. The bilirubin levels were compared between the END group and No END group. The correlations of bilirubin with END were assessed according to the bilirubin tertiles on the cohort of different genders.

Results: In women, as the bilirubin level increased, the occurrence of END showed an increasing trend. The linear association was significant based on the tertiles of all bilirubin types (TBIL p = 0.003; DBIL p = 0.025; IBIL p = 0.025), while in men no similar trend was observed. After adjustment for confounders, higher TBIL (p for trend 0.009) and DBIL (p for trend 0.033) levels were associated with increased risk of END in women. The adjusted OR for T3 relative to T1 was 5.240 (95% CI 1.496–18.347) in TBIL and 3.549 (95% CI 1.089–11.566) in DBIL. Multivariate logistic regression showed that DBIL was independently associated with END in women (OR 1.717, 95% CI 1.106–2.666). The study also found that DBIL was superior to TBIL and IBIL in prediction of END occurrence in women, with greater predictive value.

Discussion: There were gender differences in the relationship between bilirubin and END, and DBIL level was positively associated with END occurrence in women, not in men. DBIL had greater incremental predictive value for END than TBIL and IBIL.

Nomogram including indirect bilirubin for the prediction of post-stroke depression at 3 months after mild acute ischemic stroke onset

You do realize that survivors don't want to hear you predicting their post stroke depression. They want protocols for 100% recovery that will prevent depression! 

Or are you that much of complete blithering idiots? Ok, the truth hurts, doesn't it?

Nomogram including indirect bilirubin for the prediction of post-stroke depression at 3 months after mild acute ischemic stroke onset

Yanyan Wang¹, Wenzhe Sun¹, Jinfeng Miao¹, Zhou Zhu¹, Wenwen Liang¹, Xiuli Qiu¹, Chensheng Pan¹, Guo Li¹, Yan Lan¹, Xin Zhao^1* and Yi Xu^2*

• ¹Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
• ²Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

Background: Post-stroke depression (PSD) has been proven to be associated with stroke severity. Thus, we hypothesized that the prevalence of PSD would be lower in patients with mild stroke. We aim to explore predictors of depression at 3 months after mild acute ischemic stroke (MAIS) onset and to develop a practical and convenient prediction model for the early identification of patients at high risk.

Methods: A total of 519 patients with MAIS were consecutively recruited from three hospitals in Wuhan city, Hubei province. MAIS was defined as a National Institute of Health Stroke Scale (NIHSS) score of ≤5 at admission. Meeting the DSM-V diagnostic criteria and a 17-item Hamilton Rating Scale for Depression (HAMD-17) score of >7 at their 3-month follow-up were considered the primary outcomes. A multivariable logistic regression model was used to determine the factors adjusted for potential confounders, and all independent predictors were brought into the construction of a nomogram to predict PSD.

Results: The prevalence of PSD is up to 32% at 3 months after MAIS onset. After adjusting for potential confounders, indirect bilirubin (p = 0.029), physical activity (p = 0.001), smoking (p = 0.025), hospitalization days (p = 0.014), neuroticism (p < 0.001), and MMSE (p < 0.001) remained independently and significantly related with PSD. The concordance index (C-index) of the nomogram jointly constructed by the aforementioned six factors was 0.723 (95% CI: 0.678–0.768).

Conclusion: The prevalence of PSD seems equally high even if the ischemic stroke is mild, which calls for great concern from clinicians. In addition, our study found that a higher level of indirect bilirubin can lower the risk of PSD. This finding may provide a potential new approach to PSD treatment(You don't need to treat PSD if you prevent it by 100% recovery protocols). Furthermore, the nomogram including bilirubin is convenient and practical to predict PSD after MAIS onset.

Introduction

Post-stroke depression (PSD), as one of the most frequent psychiatric complications of cerebrovascular lesions, is closely linked to decreased functional status and higher mortality rates, which not only reduces the quality of life of patients but also places a heavy burden on caregivers (1–3). A new review reported that PSD prevalence was extremely high within 3 months after the acute event in the total stroke population (4), and our previously published literature showed that the overall prevalence of PSD at 3 months after stroke was up to 39.7% (5). Furthermore, a host of studies presented that there was a strong association between stroke severity and PSD (1, 2, 6).

In clinical practice, the National Institute of Health Stroke Scale (NIHSS) is widely used to evaluate the severity of stroke (7), and mild stroke was defined as an NIHSS score of ≤5 (8, 9). An interesting study showed that despite a low NIHSS, patients with mild stroke who have recovered well continue to experience psychological consequences such as PSD and fatigue (10). The prevalence of depression after a minor ischemic stroke has been reported to be 26% 1 year after the stroke onset (11). Without timely identification and proper treatment, patients with long-term mood disorders after mild stroke could have a worse quality of life and may find it difficult to return to work and their social activities (12).

Currently, the literature on predicting PSD after mild stroke is still relatively scarce, the lack of data in this field provided the impetus for the study reported herein. To this end, we examine the prevalence and explore independent predictors of depression at 3 months after mild acute ischemic stroke (MAIS) onset. Moreover, we are committed to establishing a practical predictive nomogram of PSD to guide clinical decision-making.

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

 You blithering idiots, survivors don't want predictions of cognitive impairment, they want prevention of that. Do you even have two neurons to rub together to think at all? When 50% of survivors have cognitive impairment, don't you think just maybe you should solve that problem?  I'd have you all fired.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis 

Show all authors

Emily Louise Ball, Mahnoor Shah, Eilidh Ross, ...

First Published August 4, 2022 Research Article 

https://doi.org/10.1177/17474930221120349

Article information

Abstract

Background:

Stroke survivors are at an increased risk of developing post-stroke cognitive impairment and post-stroke dementia; those at risk could be identified by brain imaging routinely performed at stroke onset.

Aim:

This systematic review aimed to identify features which are associated with post-stroke cognitive impairment (including dementia), on magnetic resonance imaging (MRI) performed at stroke diagnosis.

Summary of review:

We searched the literature from inception to January 2022 and identified 10,284 records. We included studies that performed MRI at the time of stroke (0-30 days after a stroke) and assessed cognitive outcome at least three months after stroke. We synthesised findings from 26 papers, comprising 27 stroke-populations (N=13,114, average age range=40-80 years, 19-62% female). When data were available, we pooled unadjusted (ORu) and adjusted (ORa) odds ratios.

We found associations between cognitive outcomes and presence of cerebral atrophy (3 studies, N=453, ORu=2.48, 95%CI=1.15-4.62), presence of microbleeds (2 studies, N=9151, ORa=1.36, 95%CI=1.08-1.70), and increasing severity of white matter hyperintensities (3 studies, N=704, ORa=1.26, 95%CI=1.06-1.49). Increasing cerebral small vessel disease score was associated with cognitive outcome following unadjusted analysis only (2 studies, N=499, ORu=1.34, 95%CI=1.12-1.61; 3 studies, N=950, ORa=1.23, 95%CI=0.96-1.57). Associations remained after controlling for pre-stroke cognitive impairment. We did not find associations between other stroke features and cognitive outcome, or there were insufficient data.

Conclusions:

Acute stroke MRI features may enable healthcare professionals to identify patients at risk of post-stroke cognitive problems. However, there is still substantial uncertainty about the prognostic utility of acute MRI for this.

Keywords

Stroke, Cognitive impairment, Dementia, Neuroimaging, MRI, Post-stroke cognitive impairment

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Bile pigment may provide natural protection from heart attacks

But will it do the same for protection against stroke? WHOM will do the research to find out? Nothing will be done because we have no stroke leadership or strategy.
http://www.news-medical.net/news/20151126/Bile-pigment-may-provide-natural-protection-from-heart-attacks.aspx

New hope in the fight against cardiovascular disease has arrived, following breakthrough research identifying a pigment in our bile which could protect us.
A fluid produced by the liver and stored in the gallbladder, bile's function is to aid the digestion process.
Now Dr Andrew Bulmer from Griffith University's Menzies Health Institute Queensland (MHIQ) has found that mildly elevated levels of a bile pigment called bilirubin may provide natural protection from heart attacks and help to stave off cardiovascular disease.
Published recently in the International Journal of Cardiology, the study shows that when hearts are infused with bilirubin following a heart attack, the pigment reduces damage and improves heart function during recovery.
"This is a very important finding as very few drugs are able to be administered following a heart attack to improve heart function," says Dr Bulmer. "Generally, if it is a small heart attack people can survive. However there is a 20 per cent mortality rate from heart attack, with approximately 50,000 heart attack sufferers each year in Australia.

"Generally, bilirubin was just associated with people having jaundice; however we have now shown that mildly elevated bilirubin is actually beneficial, naturally protecting an individual against cardiovascular disease."
Additional research - just published in Free Radical Biology and Medicine - has shown that higher levels of bilirubin can protect the circulation from oxidative damage that causes blood vessel disease. "We believe that this protection could be related to recently identified anti-oxidative property of the bilirubin molecule," says Dr Bulmer.
"Inflammation is the main culprit of damage to the body and is caused by over-active white blood cells that release 'free radicals'. It appears our natural bilirubin can protect from these free radicals during chronic inflammatory diseases like cardiovascular disease, kidney disease and diabetes."
Currently, 5-10 per cent of the population is believed to have mildly elevated levels of bilirubin in their blood - a condition with no negative side effects called Gilbert's Syndrome. People with this syndrome have a 30-60 per cent reduced chance of having cardiovascular disease and a 50 per cent reduced risk from dying of any cause.
Dr Bulmer says that his findings could have positive implications for reducing health risks and improving life expectancy, as a result of increasing the bilirubin concentration in people who have low levels of the pigment in blood.
"Not only is there a benefit in being able to use bilirubin as a biomarker for measuring people's future risk of various chronic diseases, there is a very real possibility it could be used as a treatment after a heart attack to reduce damage to the heart and possibly improve survival," he says.

Source:

Griffith University

Bilirubin is an antioxidant of possible physiological importance

To give some more context to my earlier post.
http://www.sciencemag.org/content/235/4792/1043.short

Abstract

Bilirubin, the end product of heme catabolism in mammals, is generally regarded as a potentially cytotoxic, lipid-soluble waste product that needs to be excreted. However, it is here that bilirubin, at micromolar concentrations in vitro, efficiently scavenges peroxyl radicals generated chemically in either homogeneous solution or multilamellar liposomes. The antioxidant activity of bilirubin increases as the experimental concentration of oxygen is decreased from 20% (that of normal air) to 2% (physiologically relevant concentration). Furthermore, under 2% oxygen, in liposomes, bilirubin suppresses the oxidation more than alpha-tocopherol, which is regarded as the best antioxidant of lipid peroxidation. The data support the idea of a "beneficial" role for bilirubin as a physiological, chain-breaking antioxidant.

Association between serum total bilirubin level and leukoaraiosis in Korean adults.

leukoaraiosis - white matter disease is a term for changes in the cerebral white matter that can be detected with high frequency by CT and MRI in aged individuals.
It is also commonly referred to as white matter hyperintensities (WMH) due to its bright white appearance on T2 MRI scans.
http://www.ncbi.nlm.nih.gov/pubmed/22245549

Abstract

OBJECTIVES:

Leukoaraiosis is associated with cerebrovascular microangiopathy. Increasing evidence suggests that bilirubin is a potent cytoprotectant in the development of cardiovascular diseases. This study aimed to determine whether total bilirubin is related to leukoaraiosis.

METHODS:

We examined the relationship of total bilirubin with leukoaraiosis in 1331 Korean adults. The odds ratios for leukoaraiosis were calculated using multivariate logistic regression across serum total bilirubin tertiles.

RESULTS:

In comparison with the subjects in the reference group (total bilirubin: 15-26μmol/L), the odds ratio (95% CI) for leukoaraiosis in the 3rd tertile (total bilirubin ≤10μmol/L) was 5.50 (1.24-24.40) in women after adjusting for confounding variables. However, this inverse association between serum total bilirubin and the prevalence of leukoaraiosis was not found in men after adjusting for the same co-variables.

CONCLUSION:

Total bilirubin level was inversely associated with leukoaraiosis regardless of classical cardiovascular risk factors in Korean women.

Ok, so what should we research next? Raising the bilirubin level?