A Meta-Analysis Of The Relationship Between Different Types Of Serum Bilirubin And Stroke Risk,Severity And Prognosis

Objective:Stroke is the second leading cause of death and the third leading cause of disability among adults worldwide.Oxidative stress plays an important role in the occurrence and development of stroke.Bilirubin is one of the most powerful antioxidants in the body.It is very necessary to fully understand and clarify the role bilirubin plays in the occurrence and development of stroke.Methods: By constructing a search strategy,the relevant literatures were selected from seven databases including Pub Med,Web of science,China National Knowledge Infrastructure,Wanfang Database,Cochrane,China Biomedical Literature Database and Weipu Chinese Journal Service platform as of January 30,2023.And the quality of the literature is strictly screened and evaluated.The dose-response curves of different types of bilirubin and risk,severity and prognosis of stroke were fitted with restricted cubic cubic splines.Stata 12.0 software was used for statistical analysis.Results: 1.The risk of total stroke was negatively correlated with total bilirubin(OR:0.91,95%CI:0.86-0.96),and every 1μmol/L increase in total bilirubin level was associated with a 1% decrease in total stroke risk(OR: 0.99,95% CI: 0.99 to 1.00).We also found that total bilirubin levels were lower in the group with total stroke than in the group without stroke(WMD:-3.85,95%CI:-6.03--1.67).This study also found that total bilirubin was negatively correlated with the risk in ischemic stroke(OR:0.74,95%CI:0.62-0.85).Every 1μmol/L increase in total bilirubin level was associated with a1% reduction in the risk in ischemic stroke(OR: 0.99,95%CI:0.99-1.00).Indirect bilirubin was also negatively associated with the risk in ischemic stroke(OR:0.50,95%CI: 0.33-0.60).2.The severity of ischemic stroke was positively correlated with total bilirubin(OR:1.06,95%CI: 1.02-1.11).Direct bilirubin was linearly positively associated with ischemic stroke severity(OR:1.21,95%CI: 1.08-1.35),and Each 1μmol/L increase in direct bilirubin level may be associated with a 1% increase in moderate or severe ischemic stroke(OR: 1.01,95%CI: 1.00,1.01),and the concentration of direct bilirubin in moderate to severe patients was higher than that in mild patients(WMD: 1.40,95%CI: 0.39-2.40).3.This study found that poor prognosis of ischemic stroke is associated with direct bilirubin(OR: 1.25,95%CI: 1.10-1.41).There was a positive correlation between direct bilirubin and mortality in patients with ischemic stroke(OR: 1.85,95%CI: 1.06-2.24).There was also a positive association between indirect bilirubin and mortality in patients with ischemic stroke(OR: 1.61,95%CI:1.07-2.15).Conclusion: The risk of total stroke and ischemic stroke was negatively correlated with total bilirubin.Every 1μmol/L increase in total bilirubin level was associated with a 1%decrease in the risk of total stroke and ischemic stroke.The risk of ischemic stroke was also negatively associated with indirect bilirubin.The severity of ischemic stroke was linearly positively correlated with total bilirubin and direct bilirubin.Every 1μmol/L increase in direct bilirubin level was associated with a 1% increase in the risk of progression to moderate to severe ischemic stroke.Direct bilirubin is associated with poor prognosis in ischemic stroke;and there was a positive correlation between indirect bilirubin and direct bilirubin and mortality of patients with ischemic stroke.