Title : The association between the risk of ischemic stroke and liver enzymes level: A systematic review and meta-analysis
Abstract:
Background and Aims: Ischemic stroke is a major public health concern, contributing significantly to global morbidity and mortality. Recent studies 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. We aim to examine the potential role of liver enzymes as biomarkers for ischemic stroke.
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. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale assessed the certainty of evidence.
Results: Increased levels of gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) showed 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 association.
Audience Take Away Notes:
- Higher GGT enzyme levels were significantly correlated with higher risk of ischemic stroke
- Higher ALP enzyme level was significantly correlated with increasing the risk of ischemic stroke
- No significant correlation was found between increasing risk of ischemic stroke with neither ALT nor AST enzymes levels
- Careful monitoring and follow up is essential for patients with high levels of GGT and ALP enzymes for early detection and treatment of ischemic stroke
