The Association Between Risk Of Ischemic Stroke And Liver Enzymes Levels: A Systematic Review and Meta-analysis
Omnia Samy El-sayed1, Asmaa Zakria Alnajjar2, Abdelfattah Arafa3, Hazem E. Mohammed4, Abdelrahman M. Elettreby5, Safiya Ibraheem6, Dalia Esam Tawfik7, Menna Allah Ashraf Abdullah8, Mohamed Ahmed Tolba7
1Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt, 2Faculty of Medicine, Al-Azhar university, Gaza, Palestine, 3Faculty of Medicine, Al-Azhar University, Damietta, Egypt, 4Faculty of Medicine, Assiut University, Assiut, Egypt, 5Faculty of Medicine, Mansoura University, Mansoura, Egypt, 6Faculty of Medicine, Minia university, Minia, Egypt, 7Faculty of Medicine, MUST University, Giza, Egypt, 8Faculty of Medicine, Nahda University in Beni Suef (NUB), Beni Suef, Egypt
Objective:
To examine the potential role of liver enzymes as biomarkers for ischemic stroke.
Background:
Ischemic stroke is a major public health concern, contributing significantly to global morbidity and mortality. Recent studies have suggested that alterations in liver enzymes may be linked to the risk of developing a stroke. However, the relationship between liver enzymes and ischemic stroke remains unclear.
Design/Methods:
We systematically searched four databases for articles investigating the association between liver enzymes and ischemic stroke up to March 20th, 2024. Newcastle Ottawa Scale judged the quality of included studies. Risk ratio (RR), hazard ratio (HR), or odds ratio (OR) were extracted and statistically analyzed by RevMan and R software. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessed the certainty of evidence.
Results:
Increased levels of gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) have shown statistically significant association with increased ischemic stroke risk (RR: 1.43, 95% CI: [1.30 to 1.57], P > 0.00001) and (RR: 1.60, 95% CI: [1.22 to 2.10], P = 0.0006), respectively. Conversely, increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) showed no significant association with ischemic stroke risk (RR: 0.92, 95% CI: [0.68 to 1.24], P = 0.58) and (RR: 1.43, 95% CI: [0.83 to 2.49], P = 0.20), respectively. The evidence for all outcomes had a low or very low level of certainty.
Conclusions:
GGT and ALP could be potential biomarkers for increased ischemic stroke risk, which necessitates careful follow-up. However, AST and ALT did not show such an association.
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