Open Access Highly Accessed Research article

Changes of liver enzymes and bilirubin during ischemic stroke: mechanisms and possible significance

Antonio Muscari12*, Andrea Collini2, Elisa Fabbri2, Marco Giovagnoli2, Chiara Napoli2, Valentina Rossi2, Luca Vizioli2, Andrea Bonfiglioli1, Donatella Magalotti1, Giovanni M Puddu1 and Marco Zoli12

Author Affiliations

1 Stroke Unit – Department of Internal Medicine, Aging and Nephrological Diseases, S. Orsola-Malpighi Hospital, Via Albertoni, 15, Bologna 40138, Italy

2 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

For all author emails, please log on.

BMC Neurology 2014, 14:122  doi:10.1186/1471-2377-14-122

Published: 6 June 2014



Small changes of bilirubin and liver enzymes are often detected during the acute phase of stroke, but their origin and significance are still poorly understood.


On days 0, 3, 7, and 14 after admission, 180 patients with ischemic stroke underwent serial determinations of bilirubin, GOT, GPT, γGT, alkaline phosphatase, C-reactive protein (CRP) and complete blood count. On days 0 and 7 common bile duct diameter was measured by ultrasound, and on day 3 cerebral infarct volume (IV) was calculated from CT scan slices.


During the first week GOT, GPT, γGT (P < 0.001) and CRP (P = 0.03) increased with subsequent plateau, while significant decrements (P < 0.001) concerned unconjugated bilirubin, erythrocytes and haemoglobin. Alkaline phosphatase, direct bilirubin and common bile duct diameter remained stable. IV correlated with CRP, leukocytes, GOT, γGT (r > 0.3, P < 0.001 for all) and direct bilirubin (r = 0.23, P = 0.008). In multivariate analysis only CRP and GOT remained independently associated with IV (P < =0.001). The correlation of IV with GOT increased progressively from admission to day 14. GOT independently correlated with GPT which, in turn, correlated with γGT. γGT was also highly correlated with leukocytes. Unconjugated bilirubin correlated with haemoglobin, which was inversely correlated with CRP.


The changes of bilirubin and liver enzymes during ischemic stroke reflect two phenomena, which are both related to IV: 1) inflammation, with consequent increment of CRP, leukocytes and γGT, and decrease of haemoglobin and unconjugated bilirubin and 2) an unknown signal, independent from inflammation, leading to increasing GOT and GPT levels.

Bilirubin; C-reactive protein; γGT; GOT; GPT; Ischemic stroke; Liver