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Abstract

Background: Oxidative injury is an important cause of the neurologic lesion in stroke. Serum bilirubinis considered a natural antioxidant that may affect the prognosis of stroke. The purpose of this studywas to evaluate the prognostic significance of bilirubin in stroke patients. Methods: A prospectivecross-sectional study was conducted in Medical Units of Khyber Teaching Hospital, Peshawar.Inpatients admitted with acute attack of stroke were included in this study. Data regarding serumbilirubin and concurrent cerebrovascular risk factors were collected. National Institutes of HealthStroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to analyse stroke's severity andfunctional outcomes, respectively. Results: Hypertension, diabetes mellitus and heart diseases were themost common risk factors. Patients were divided into 3 groups on the basis of serum bilirubin, i.e., ‰¤0.6mg/dl (Group-1), 0.7-0.9 mg/dl (Group-2), and ‰¥1.0 mg/dl (Group-3). The mean pre-hospitalisationNIHSS score for Groups 1, 2 and 3 was 5.62, 11.66 and 25.33, respectively; and post-hospitalisationscore was 0.875, 3.76 and 16.26, respectively. The pre-hospitalisation mRS score was 4 for Group-1,4.52 for Group-2 and 4.93 for Group-3; while post-hospitalisation Mrs Score was 1.50, 2.38 and 4.26,respectively. Average serum bilirubin level was significantly higher in patients with poor outcomes ascompared with good outcomes (p<0.01). Conclusions: This study suggests that higher serum bilirubinlevels were associated with increased stroke severity, longer hospitalisation and poor prognosis.Keywords: Stroke severity, stroke outcome, stroke prognosis, serum bilirubin, National Institutes ofHealth Stroke Scale (NIHSS), modified Rankin Scale (mRS)