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Published on: August 1, 2018
High mortality in cirrhotic patients following hemorrhagic stroke
Tsung-Hsing Hung1, Yu-Hsi Hsieh1, Kuo-Chih Tseng1
1Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi County 62247, Taiwan; School of Medicine, Tzu Chi University, Hualien County, Taiwan.
Insights
Hemorrhagic stroke (HS) significantly increases mortality risk in cirrhotic patients. This study found HS patients faced a nearly four-fold higher 90-day mortality rate compared to those without HS.
Area of Science:
- Hepatology
- Neurology
- Critical Care Medicine
Background:
- Cirrhosis is a severe liver condition associated with increased mortality.
- The specific impact of hemorrhagic stroke (HS) on mortality in cirrhotic patients remains largely uncharacterized.
Purpose of the Study:
- To investigate the mortality risk associated with hemorrhagic stroke (HS) in patients diagnosed with cirrhosis.
- To quantify the increased mortality hazard in cirrhotic patients experiencing HS.
Main Methods:
- Utilized the Taiwan National Health Insurance Database for patient data from 2007.
- Included 321 cirrhotic patients with HS and a control group of 3210 cirrhotic patients without HS.
- Employed Cox proportional hazard regression analysis, adjusting for demographic and comorbidity factors.
Main Results:
- The 90-day mortality rate was substantially higher in the HS group (43.0%) compared to the non-HS group (17.7%).
- Adjusted Cox regression revealed a hazard ratio (HR) of 3.89 for 90-day mortality in cirrhotic patients with HS.
- Subgroup analysis indicated a particularly high HR of 7.93 for subarachnoid hemorrhage within the HS group.
Conclusions:
- Hemorrhagic stroke presents a significant and independent risk factor for increased 90-day mortality in patients with cirrhosis.
- Subarachnoid hemorrhage, a type of HS, confers an approximately eight-fold increased mortality risk in this vulnerable patient population.
Abstract:
The impact of hemorrhagic stroke (HS) on the mortality of cirrhotic patients is unknown. To evaluate the morality risk of HS in cirrhotic patients, we used the Taiwan National Health Insurance Database to evaluate cirrhotic patients with HS who were discharged between 1 January and 31 December 2007. In total, there were 321 cirrhotic patients with HS. We randomly selected 3210 cirrhotic patients without HS as a comparison group. The 30 and 90 day mortality rates were 29.6% and 43.0% in the HS group, and 9.1% and 17.7% in the comparison group, respectively (p<0.001). After Cox proportional hazard regression model adjustment of patients' sex, age, and other comorbid disorders, the hazard ratio (HR) for 90 day mortality in the HS group was 3.89 (95% confidence interval [CI] 3.20-4.71, p<0.001), compared to the comparison group. In the subgroup analysis, the HR for 90 day mortality in the subarachnoid hemorrhage and other HS groups were 7.93 (95% CI 5.23-12.0, p<0.001) and 3.51 (95% CI 2.85-4.32, p<0.001), respectively, compared to the comparison group. In conclusion, HS is associated with a very high 90 day mortality risk in cirrhotic patients, in whom subarachnoid hemorrhage can also increase the risk of mortality eight-fold.
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