Alkaline Phosphatase and Outcomes in Patients With Preserved Renal Function: Results From China National Stroke Registry

Published on Jan 1, 2018in Stroke7.19
· DOI :10.1161/STROKEAHA.118.020237
Lixia Zong3
Estimated H-index: 3
Xianwei Wang12
Estimated H-index: 12
+ 6 AuthorsYongjun Wang53
Estimated H-index: 53
Background and Purpose— Alkaline phosphatase (ALP) is associated with risk of adverse cardiovascular events in patients with kidney failure. However, there is little data about effects of ALP on stroke outcomes in patients with preserved kidney function. The study aimed to explore the association between serum ALP level and clinical outcomes after stroke in patients with preserved kidney function. Methods— We included 16 367 stroke patients with preserved kidney function from the China National Stroke Registry for current analysis. Serum ALP levels were tested by automated enzymatic method using unfrozen samples in each center. Participants were divided into 5 groups according to ALP quintiles. Composite end point comprised of recurrent stroke, myocardial infarction, other ischemic vascular events, and all-cause mortality. Poor functional outcome is defined as modified Rankin Scale score of 3 to 6. Multivariable logistic regression was used to evaluate the independent association of serum ALP with 1-year all-cause mortality, recurrent stroke, composite end point, and poor functional outcome. Results— The mean age of the included 16 367 patients was 63.9 years, and 63.3% of them were men. Among the top ALP quintile (>98.0 U/L), 1-year incidences of all-cause mortality, recurrent stroke, composite end point, and poor functional outcome were 12.6%, 5.7%, 14.4%, and 27.0%, respectively. Compared with the lowest ALP quintile (≤59.0 U/L), the adjusted odds ratios of the top quintile were 1.36 (1.10–1.68) for all-cause mortality, 1.45 (1.11–1.90) for stroke recurrence, 1.35 (1.12–1.63) for composite end point, and 1.36 (1.17–1.60) for poor functional outcome. There was no significant interaction between age, sex, or alcohol consumption and ALP ( P for interaction ≥0.10) for all outcomes. Conclusions— In patients with preserved kidney function, ALP may be an independent predictor of all-cause mortality, stroke recurrence, composite end point, and poor functional outcome after stroke.
📖 Papers frequently viewed together
20192.50BMJ Open
10 Authors (Tongtong Yu, ..., Zhaoqing Sun)
1 Citations
9 Citations
7 Authors (Tetsuro Ago, ..., Masahiro Kamouchi)
18 Citations
#1Mathias Haarhaus (Linköping University)H-Index: 12
#2Vincent Brandenburg (RWTH Aachen University)H-Index: 59
Last. Per Magnusson (Linköping University)H-Index: 24
view all 5 authors...
Cardiovascular disease is the main cause of early death in the settings of chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and ageing. Cardiovascular events can be caused by an imbal ...
78 CitationsSource
#1Bala WaziriH-Index: 3
#2Raquel DuarteH-Index: 14
Last. Saraladevi NaickerH-Index: 28
view all 3 authors...
Objective. To determine the association between serum total alkaline phosphatase (TAP) and mortality in African maintenance haemodialysis patients (MHD). Patients and Methods. The study enrolled a total of 213 patients on MHD from two dialysis centers in Johannesburg between January 2009 and March 2016. Patients were categorized into a low TAP group (≤112 U/L) versus a high TAP group (>112 U/L) based on a median TAP of 112 U/L. Results. During the follow-up period of 7 years, there were 55 (25.8...
6 CitationsSource
#1Ge Tan (Sichuan University)H-Index: 5
#2Zilong Hao (Sichuan University)H-Index: 19
Last. Ming Liu (Sichuan University)H-Index: 15
view all 7 authors...
Whether subclinical change of liver function is associated with outcome of spontaneous intracerebral hemorrhage remains to be an open question. A total of 639 patients of spontaneous intracerebral hemorrhage within 7 days from stroke onset were finally enrolled. Liver function indicators, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin (BIL), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), albumin (ALB), and international normalized ratio (I...
9 CitationsSource
#1Kunihiro Matsushita (Johns Hopkins University)H-Index: 77
#2Josef Coresh (Johns Hopkins University)H-Index: 167
Last. Johan Ärnlöv (Dalarna University)H-Index: 95
view all 25 authors...
Summary Background The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta-analytic approach. Methods We meta-analysed individual-level data for 637 315 individuals without a history of cardiovascular disease from 24 cohorts (median follow-up 4·2–19·0 years) included...
298 CitationsSource
#1Nada El Husseini (Wake Forest Baptist Medical Center)H-Index: 11
#2Omran Kaskar (Wake Forest Baptist Medical Center)H-Index: 2
Last. Larry B. Goldstein (Wake Forest Baptist Medical Center)H-Index: 95
view all 3 authors...
Chronic kidney disease (CKD) is associated with an increased risk of both ischemic and hemorrhagic stroke. In addition to shared risk factors, this higher cerebrovascular risk is mediated by several CKD-associated mechanisms including platelet dysfunction, coagulation disorders, endothelial dysfunction, inflammation, and increased risk of atrial fibrillation. CKD can also modify the effect of treatments used in acute stroke and in secondary stroke prevention. We review the epidemiology and patho...
21 CitationsSource
#1Xianwei Wang (Capital Medical University)H-Index: 12
#2Yang Luo (Capital Medical University)H-Index: 8
Last. Yongjun Wang (Capital Medical University)H-Index: 53
view all 9 authors...
Background The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation estimates glomerular filtration rate (GFR) more precisely than the MDRD (Modification of Diet in Renal Disease) Study equation. The risk implications of this equation have been compared with the MDRD Study equation in different demographic and clinical characteristics. However, whether a Chinese modification of this equation performs better than a Chinese modification of the MDRD Study equation in risk...
23 CitationsSource
#1Jinkwon Kim (Ewha Womans University)H-Index: 22
#2Tae-Jin SongH-Index: 18
Last. Ji Hoe HeoH-Index: 57
view all 8 authors...
Background and Purpose—Higher serum alkaline phosphatase (ALP) and phosphate levels are associated with atherosclerotic disease and an increased risk of cardiovascular events. However, the association of ALP/phosphate with cerebral atherosclerosis and prognosis in patients with acute stroke is not well known. Methods—In 1034 patients with first-ever acute cerebral infarction, levels of ALP and phosphate were compared with (1) cerebral atherosclerosis and (2) poor long-term functional outcomes as...
25 CitationsSource
#1Yuji Shimizu (Osaka University)H-Index: 17
#2Hironori Imano (Osaka University)H-Index: 29
Last. Hiroyasu Iso (Osaka University)H-Index: 101
view all 11 authors...
Although serum alkaline phosphatase (ALP) levels have been associated with mortality from all-cause and from either ischemic or hemorrhagic stroke, no study has been published of the associations between ALP and the incidence of stroke. We therefore examined the associations of ALP with risk of stroke among Japanese, stratified by drinking status because ALP is known as an enzyme affected by alcohol consumption. We conducted a prospective cohort study of 10,754 Japanese subjects (4098 men and 66...
23 CitationsSource
#1Rudolph Schutte (NWU: North-West University)H-Index: 21
#2Hugo W. Huisman (NWU: North-West University)H-Index: 26
Last. Aletta E. Schutte (NWU: North-West University)H-Index: 62
view all 10 authors...
Abstract Background Vascular calcification is believed to be due to the conversion of vascular smooth muscle cells into osteoblast-like cells and is associated with mortality. Since hypertension and related mortality in Africans is a concern, we investigated associations between a marker of osteoblastic activity, alkaline phosphatase (ALP), and measures of arterial structure and function in hypertensive African men. Methods This study included 79 participants. We conducted 24h ambulatory blood p...
14 CitationsSource
#1SG Wannamethee (UCL: University College London)H-Index: 51
#2Naveed SattarH-Index: 172
Last. Peter H. WhincupH-Index: 128
view all 5 authors...
Objective— We have examined the association between serum phosphate and alkaline phosphatase (ALP) with incident cardiovascular disease (CVD) outcomes and total mortality in older men. Approach and Results— A prospective study of 3381 men, aged 60 to 79 years, without a history of myocardial infarction or stroke followed up for an average 11 years during which there were 605 major CVD events (fatal coronary heart disease and nonfatal myocardial infarction, stroke, and CVD death) and 984 total de...
73 CitationsSource
Cited By12
#1Hiroyuki Naito (Hiroshima University)H-Index: 5
#2Tomohisa Nezu (Hiroshima University)H-Index: 14
Last. Hirofumi Maruyama (Hiroshima University)H-Index: 32
view all 13 authors...
AIMS Elevated serum alkaline phosphatase (ALP) levels are associated with an increased risk of cerebrocardiovascular diseases. However, the associations of ALP with peripheral arterial disease (PAD) and outcomes in patients with acute ischemic stroke (AIS) are not well-known. METHODS We examined the association between ALP levels and the ankle-brachial index (ABI) in 2111 consecutive patients with AIS. A poor functional outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 3 month...
#1Tomohisa Nezu (Hiroshima University)H-Index: 14
#2Naohisa Hosomi (Hiroshima University)H-Index: 29
Last. Hirofumi Maruyama (Hiroshima University)H-Index: 32
view all 16 authors...
AIM The prediction of functional outcome is essential in the management of acute ischemic stroke patients. We aimed to explore the various prognostic factors with multivariate linear discriminant analysis or neural network analysis and evaluate the associations between candidate factors, baseline characteristics, and outcome. METHODS Acute ischemic stroke patients (n=1,916) with premorbid modified Rankin Scale (mRS) scores of 0-2 were analyzed. The prediction models with multivariate linear disc...
#1Yuya Yokota (Okayama University)
#2Yoshito Nishimura (Okayama University)H-Index: 5
Last. Fumio Otsuka (Okayama University)H-Index: 35
view all 10 authors...
Alkaline phosphatase (ALP) is an enzyme that is expressed in a variety of tissues. Among the isoforms of ALP, bone-specific alkaline phosphatase (BAP) is used as a marker for evaluating bone metabolism. We investigated the clinical usefulness of the ratio of serum BAP to total ALP for the diagnosis of various disorders in general practice. We retrospectively analyzed the cases of 107 Japanese patients whose serum BAP levels were exam-ined, focusing on clinical characteristics. We observed that t...
#1Zhongzhong Liu (Northwest University (United States))
#2Wenjuan Lin (Northwest University (United States))
Last. Songdi Wu (Northwest University (United States))H-Index: 2
view all 11 authors...
The prevalence of stroke recurrence, disability, and all-cause mortality of patients with minor ischemic stroke (MIS) remains problematic. The aim of the present study was to identify risk factors associated with adverse outcomes at 1 year after MIS in the Xi’an region of China. This prospective cohort study included MIS patients above 18 years old with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January ...
#1Claudia Goettsch (RWTH Aachen University)H-Index: 32
#2Agnieszka Strzelecka-Kiliszek (Nencki Institute of Experimental Biology)H-Index: 12
Last. David Magne (UCBL: Claude Bernard University Lyon 1)H-Index: 30
view all 10 authors...
Cardiovascular calcification (CVC) is associated with increased morbidity and mortality. It develops in several diseases and locations, such as in the tunica intima in atherosclerosis plaques, in the tunica media in type 2 diabetes and chronic kidney disease, and in aortic valves. In spite of the wide occurrence of CVC and its detrimental effects on cardiovascular diseases (CVD), no treatment is yet available. Most of CVC involve mechanisms similar to those occurring during endochondral and/or i...
1 CitationsSource
#1Toshiyuki UeharaH-Index: 14
#2Koji YoshidaH-Index: 1
Last. Yasushi KitaH-Index: 11
view all 5 authors...
Abstract Objective The purpose of this study was to determine whether increased alkaline phosphatase (ALP) was associated with early neurological deterioration (END) in patients with atherothrombotic brain infarction (ATBI) attributable to intracranial atherosclerosis (ICAS) or not. Methods We analyzed data derived from 70 patients (47 men; mean age, 72.4 ± 12.8 years) with symptomatic ICAS who were admitted within 3 days of ATBI onset between April 2013 and December 2018. We defined END as an i...
1 CitationsSource
#1Ilia Beberashvili (TAU: Tel Aviv University)H-Index: 16
#2Oleksandra Samogalska (TAU: Tel Aviv University)H-Index: 1
Last. Shai Efrati (TAU: Tel Aviv University)H-Index: 26
view all 5 authors...
Objective Higher serum alkaline phosphatase (sALP) levels associate with a poor prognosis in maintenance hemodialysis patients. However, little is known about the meaning of lower sALP in this population. We hypothesized that lower sALP concentrations may express nutritional status and survival accordingly. Methods A retrospective, longitudinal cohort study of a clinical database containing the medical records of 554 patients (367 men and 187 women, mean age 67.6 ± 14.2 years) receiving maintena...
2 CitationsSource
#1Edwin K. Jackson (University of Pittsburgh)H-Index: 84
#2Dongmei Cheng (University of Pittsburgh)H-Index: 13
Last. Zaichuan Mi (University of Pittsburgh)H-Index: 29
view all 4 authors...
Here, we tested the hypothesis that TNAP (tissue nonspecific alkaline phosphatase) modulates vascular responsiveness to norepinephrine. In the isolated, Tyrode's-perfused rat mesentery, 50 µmol/L of L-p-bromotetramisole (L-p-BT; selective TNAP inhibitor, Ki=56 µmol/L) significantly reduced TNAP activity and caused a significant 9.0-fold rightward-shift in the norepinephrine concentration versus vasoconstriction relationship. At 100 µmol/L, L-p- BT further reduced mesenteric TNAP activity and cau...
#1Yu Zhu (ZJU: Zhejiang University)H-Index: 18
#2Hao Jiang (ZJU: Zhejiang University)H-Index: 6
Last. Renya Zhan (ZJU: Zhejiang University)H-Index: 15
view all 14 authors...
Background Alkaline phosphatase (ALP) has been implicated to be associated with poor outcome in ischemic stroke patients, yet its role in aneurysmal subarachnoid hemorrhage (aSAH) patients is unknown. The current study aimed to investigate the on-admission and short-term variation trend of ALP levels in aSAH patients as well as its associations with vasospasm, delayed cerebral ischemia (DCI), and outcome after aSAH.
2 CitationsSource
#1Yuan Xu (NCU: Nanchang University)H-Index: 3
#2Xinlei Yang (NCU: Nanchang University)H-Index: 2
Last. Yingping Yi (NCU: Nanchang University)H-Index: 4
view all 9 authors...
Abstract Object Ischemic stroke readmission within 90 days of hospital discharge is an important quality of care metric. The readmission rates of ischemic stroke patients are usually higher than those of patients with other chronic diseases. Our aim was to identify the ischemic stroke readmission risk factors and establish a 90-day readmission prediction model for first-time ischemic stroke patients. Methods The readmission prediction model was developed using the extreme gradient boosting (XGbo...
8 CitationsSource