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End-Stage Liver Disease in Patients with Intracranial Hemorrhage Is Associated with Increased Mortality: A Cohort

Carlito Lagman1, Daniel T Nagasawa1, John P Sheppard1

  • 1Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.

World Neurosurgery
|February 17, 2018
PubMed

Insights

Patients with end-stage liver disease (ESLD) undergoing neurosurgery for intracranial hemorrhage (ICH) face significantly higher mortality risks. This study highlights ESLD as a critical factor impacting survival outcomes in ICH patients.

Area of Science:

  • Neurosurgery
  • Hepatology
  • Critical Care Medicine

Background:

  • Intracranial hemorrhage (ICH) presents a significant challenge in neurosurgical critical care.
  • End-stage liver disease (ESLD) is a complex condition with systemic implications.
  • The interplay between ESLD and ICH outcomes requires further investigation.

Purpose of the Study:

  • To investigate the association between end-stage liver disease (ESLD) and mortality in patients with intracranial hemorrhage (ICH).
  • To quantify the increased mortality risk in ICH patients with ESLD.
  • To identify other contributing factors to mortality in this patient population.

Main Methods:

  • Retrospective cohort study of 53 patients (33 ESLD, 20 non-ESLD) receiving neurosurgical care from 2006-2017.
  • ESLD defined by severely impaired liver function and complications.
  • Primary outcome assessed was mortality (in-hospital, 30-day, and overall survival).

Main Results:

  • ESLD cohort exhibited substantially higher in-hospital (79% vs. 20%), 30-day (64% vs. 25%), and overall mortality (79% vs. 30%) compared to non-ESLD.
  • Kaplan-Meier analysis revealed significantly worse overall survival in the ESLD group (P=0.004).
  • ESLD increased odds of overall mortality by 8.67 times, in-hospital by 14.86 times, and 30-day by 5.25 times.

Conclusions:

  • End-stage liver disease is a significant independent predictor of increased mortality in patients with intracranial hemorrhage.
  • Clinical management strategies for ICH patients should carefully consider the presence and severity of underlying liver disease.
  • Further research is warranted to explore specific interventions to mitigate mortality in this high-risk group.
Abstract

Keywords:
Intracranial hemorrhagesLiver diseasesMortalityNeurosurgery

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