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Journals / Türk Beyin Damar Hastalıkları Dergisi / 2020 / Cilt: 26 - Sayı: 2

SERUM ALBUMIN, BILIRUBIN AND PALBI SCORE AND RESPONSE TO INTRAVENOUS THROMBOLYTIC THERAPY IN ACUTE ISCHEMIC STROKE

AKUT İSKEMİK İNMEDE SERUM ALBUMİN, BİLİRUBİN VE PALBI SKORU VE İNTRAVENÖZ TROMBOLİTİK TEDAVİYE YANIT

Mehmet Yasir PEKTEZEL
ETHEM MURAT ARSAVA
Mehmet Akif TOPÇUOĞLU
Pages
157–161
DOI
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The tendency of inverse proportion between 24-hour total bilirubin level and very good functional outcome (Beta = -0.039, p = 0.148) and any degree of tPA-related cerebral hemorrhagic transformation (Beta = 0.029, p = 0.161), along with 24th hour serum albumin level and tPA-related any, but not symptomatic, cerebral hemorrhagic transformation (Beta = 0.107, p = 0.047) was disappeared or marginalized when corrected by age and NIHSS.DISCUSSION AND CONCLUSION: In acute ischemic stroke, serum albumin and bilirubin levels measured within the first 24 hours and PALBI score have no modifying role on “effect” and “side-effect” profile of IV tPA therapy.

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Objective & Hypothesis:INTRODUCTION: The search for a high utility blood marker in the context of predicting the response to intravenous (IV) thrombolytic therapy in acute ischemic stroke continues.
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Key Findings & Data:METHODS: In a total 156 acute ischemic stroke cases treated with “only” IV tissue plasminogen activator (tPA) (Age: 70 ± 13; Female 58%; NIHSS at admission: 13 ± 5.8), serum levels of albumin and total bilirubin and PALBI score determined before and twenty-four after IV tPA administration to determine their connection to the positive (NIHSS reduction greater than 4 or score becoming 0) and dramatic (NIHSS reduction 8 or more, or score down to 1 or zero) response to tPA, third month good (mRS <=2) or very good (mRS<=1) functional outcome; and development of symptomatic post-tPA intracranial hemorrhagic transformation was determined.
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Conclusion & Impact:The tendency of inverse proportion between 24-hour total bilirubin level and very good functional outcome (Beta = -0.039, p = 0.148) and any degree of tPA-related cerebral hemorrhagic transformation (Beta = 0.029, p = 0.161), along with 24th hour serum albumin level and tPA-related any, but not symptomatic, cerebral hemorrhagic transformation (Beta = 0.107, p = 0.047) was disappeared or marginalized when corrected by age and NIHSS.DISCUSSION AND CONCLUSION: In acute ischemic stroke, serum albumin and bilirubin levels measured within the first 24 hours and PALBI score have no modifying role on “effect” and “side-effect” profile of IV tPA therapy.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Abstract

INTRODUCTION: The search for a high utility blood marker in the context of predicting the response to intravenous (IV) thrombolytic therapy in acute ischemic stroke continues. The position of albumin, total bilirubin and PALBI (“Platelet- Albumin-Bilirubin”) encountered among the candidate markers has been investigated herein. METHODS: In a total 156 acute ischemic stroke cases treated with “only” IV tissue plasminogen activator (tPA) (Age: 70 ± 13; Female 58%; NIHSS at admission: 13 ± 5.8), serum levels of albumin and total bilirubin and PALBI score determined before and twenty-four after IV tPA administration to determine their connection to the positive (NIHSS reduction greater than 4 or score becoming 0) and dramatic (NIHSS reduction 8 or more, or score down to 1 or zero) response to tPA, third month good (mRS <=2) or very good (mRS<=1) functional outcome; and development of symptomatic post-tPA intracranial hemorrhagic transformation was determined. RESULTS: Serum albumin and bilirubin level and PALBI score determined before and after treatment had no effect on positive (51%) or dramatic (29%) response to IV tPA, symptomatic cerebral hemorrhagic transformation (6.4%), any type tPA-related cerebral hemorrhagic changes (25.6%), good (49.4%) and very good (34%) functional outcome in the third month. The tendency of inverse proportion between 24-hour total bilirubin level and very good functional outcome (Beta = -0.039, p = 0.148) and any degree of tPA-related cerebral hemorrhagic transformation (Beta = 0.029, p = 0.161), along with 24th hour serum albumin level and tPA-related any, but not symptomatic, cerebral hemorrhagic transformation (Beta = 0.107, p = 0.047) was disappeared or marginalized when corrected by age and NIHSS.DISCUSSION AND CONCLUSION: In acute ischemic stroke, serum albumin and bilirubin levels measured within the first 24 hours and PALBI score have no modifying role on “effect” and “side-effect” profile of IV tPA therapy.

Özet

GİRİŞ ve AMAÇ: Akut iskemik inmede intravenöz (IV) trombolitik tedaviye yanıtın öngörülebilmesi bağlamında faydalı olabilecek kan belirteci arayışı sürmektedir. Aday belirteçler arasında yer alan albumin, total bilirubin ve PALBI (“Platelet- Albumin-Bilirubin”) skorunun konumu tarafımızca araştırılmıştır. YÖNTEM ve GEREÇLER: Sadece IV doku plazminojen aktivatörü (tPA) ile tedavi edilmiş 156 olguda (Yaş: 70±13 yıl; Kadın %58; NIHSS geliş: 13±5,8) tedavi öncesi ve sonrası 24. saatte ölçülen serum albümin, total bilirubin düzeyi ve PALBI skorunun tPA’ya yanıtın pozitif (NIHSS azalması dörtten fazla veya skor sıfır) ve dramatik (NIHSS azalımı 8 veya daha fazla veya skor 1 veya sıfır), üçüncü ay fonksiyonel sonlanımın iyi (modifiye Rankin skoru-mRS ≤2) veya çok iyi (mRS≤1) olması ve semptomatik post-tPA intrakranial kanama gelişimi ile olan ilişkisi belirlenmiştir. BULGULAR: Tedavi öncesi ve sonrası serum albumin ve bilirubin düzeyi ile PALBI skoru, IV tPA’ya pozitif (%51) veya dramatik (%29) cevap, semptomatik kanama (%6,4), IV tPA’ya bağlı kanama (%25,6) üçüncü ay iyi (%49,4) ve çok iyi (%34) fonksiyonel sonuç üzerinde etki yapmamıştır. 24. saat total bilirubin düzeyinin çok iyi fonksiyonel sonlanım (Beta= -0,039, p=0,148) ve herhangi derecede tPA ilişkili kanama (Beta=0,029, p=0,161) ve tedavi sonrası albumin seviyesinin tPA ilişkili kanama (semptomatik kanama değil, Beta=0,107, p=0,047) ile ters orantılı olma eğilimi yaş ve NIHSS ile düzeltilince kaybolmuştur. TARTIŞMA ve SONUÇ: Akut iskemik inmede ilk 24 saat içindeki serum albumin ve bilirubin düzeyi ile PALBI skorunun IV tPA tedavisinin etki veya yan etkisi profilini modifiye edici etkisi yoktur.

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PEKTEZEL, M. Y., ARSAVA, E. M., TOPÇUOĞLU, M. A. (2020). SERUM ALBUMIN, BILIRUBIN AND PALBI SCORE AND RESPONSE TO INTRAVENOUS THROMBOLYTIC THERAPY IN ACUTE ISCHEMIC STROKE. Türk Beyin Damar Hastalıkları Dergisi, Cilt: 26 - Sayı: 2, 157–161. https://ajindex.com/articles/418811

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