ABSTRACT NUMBER: ESOC2026A2278 ASSOCIATION BETWEEN THE RISK OF HEMORRHAGIC STROKE AND LIVER ENZYMES LEVELS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 2,021,882 PATIENTS

Abstract Background and aims The current literature suggests that liver enzymes are implicated in stroke pathogenethesis. However, conflicting evidence regarding the association of GGT, ALP, ALT, and AST and hemorrhagic stroke risk remains unclear. We aim to explore the association between liver enzymes (GGT, ALP, AST, and ALT) and hemorrhagic stroke risk. Methods We systematically searched PubMed, Scopus, Embase, and Web of Science to identify articles investigating the association between liver enzymes and hemorrhagic strokes up to February 2025. Risk Ratio (RR), Hazard Ratio (HR), and Odds Ratio (OR) were statistically analyzed and reported using R Studio software with R (v4.4.2). Results A total of 23 studies were included, 2,021,882 participants. Increased levels of ALP and GGT were significantly associated with an increased risk of hemorrhagic stroke (RR = 1.45, 95% CI = 1.01-2.08, p = 0.043) and (RR = 1.36, 95% CI = 1.1-1.69, p = 0.0047). While AST was not significantly associated with hemorrhagic stroke (RR = 2.23, 95% CI = 0.87 5.76, p = 0.0961), higher levels of ALT demonstrated a significant association with higher risk of hemorrhagic stroke (RR = 1.18, 95% CI = 1.06-1.31, p = 0.0032). mRS 3-6 score and mortality were insignificantly associated with elevated ALP levels, (OR = 1.1, 95% CI = 0.99; 1.22, p = 0.0754) and (OR = 1.49, 95% CI = 0.58; 3.82, p = 0.4105). Conclusions ALT, ALP, and GGT emerged as positive predictors of hemorrhagic stroke risk. while AST exhibited no significant association. These enzymes could serve as potential biomarkers for hemorrhagic stroke. Conflict of interest Omnia Samy El-Sayed: nothing to disclose, Abdelfattah Arafa: nothing to disclose, Ramy Alaser: nothing to disclose, Youssef Nader: nothing to disclose, Ahmed Abo Elnaga: nothing to disclose, Momen Samy Syaj: nothing to disclose, Hind EL Azzazi: nothing to disclose, Mohamed Ahmed Ali: nothing to disclose, Ahmed F Younis: nothing to disclose, Mohamed Ahmed Tolba: nothing to disclose