Association between the levels of gamma-glutamyl transpeptidase and the risk of stroke: systematic review and meta-analysis

Abstract

Background

Stroke is influenced by numerous factors, both modifiable and non-modifiable. Among these, gamma-glutamyl transpeptidase (GGT) serves as a prognostic biomarker in cardiovascular diseases and, within this context, in neurological conditions like stroke.

Objective

To determine whether an association exists between GGT and both ischemic and hemorrhagic strokes.

Methods

A systematic and comprehensive literature search was conducted across 5 databases, encompassing studies published from their inception to January 28, 2024, following a population, exposure, comparator, outcome, and study (PECOS) framework. Ten primary studies meeting the eligibility criteria were selected.

Results

Our findings, based on a meta-analysis of the ten studies, indicate an increased risk of ischemic and hemorrhagic strokes in patients with elevated GGT levels, after excluding outliers. The analysis demonstrated a significant association, with a relative risk of 1.42 (95%CI: 1.01–1.99; I² = 19%) for hemorrhagic stroke and 1.22 (95%CI: 1.10–1.36; I² = 49%) for ischemic stroke.

Conclusion

Our study reveals an elevated risk of stroke in patients with high GGT levels, demonstrating a 42% higher likelihood of hemorrhagic stroke and a 22% increased risk of ischemic stroke.

Keywords

Gamma-Glutamyltransferase - Stroke - Ischemic Stroke - Hemorrhagic Stroke - Meta-Analysis

Authors' Contributions

Conceptualization: GAVT, SMNR; Data curation: GAVT, SMNR; Formal analysis: GAVT, SMNR; Funding acquisition: GAVT, SMNR, LJLD, WMGA; Investigation: GAVT, SMNR; Methodology: GAVT, SMNR; Project administration: GAVT, SMNR; Resources: GAVT, SMNR; Software: GAVT, SMNR; Supervision: GAVT, SMNR, CVQC; Validation: GAVT, SMNR, EDMR; Visualization: GAVT, SMNR; Writing – original draft: GAVT, SMNR, CVQC, LJLD, WMGA; Writing – review & editing: GAVT, SMNR, EDMR.

Data Availability Statement

All the data produced or examined throughout this study are fully presented within this article. Any additional questions can be addressed to the corresponding author.

Editor-in-Chief: Ayrton Roberto Massaro (https://orcid.org/0000-0002-0487-5299).

Associate Editor: Octávio Marques Pontes Neto (https://orcid.org/0000-0003-0317-843X).

Publikationsverlauf

Eingereicht: 04. Januar 2025

Angenommen: 04. Mai 2025

Artikel online veröffentlicht:
15. Juli 2025

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