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Survival Outcomes After Intracranial Hemorrhage in Liver Disease

Carlito Lagman1, Daniel T Nagasawa1, Daniel Azzam1

  • 1Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California.

Operative Neurosurgery (Hagerstown, Md.)
|May 17, 2018
PubMed

Insights

Patients with liver disease experiencing intracranial hemorrhage (ICH) have poor survival outcomes. Surgical intervention for ICH in end-stage liver disease (ESLD) patients does not clearly improve survival rates.

Area of Science:

  • Neurosurgery
  • Hepatology
  • Critical Care Medicine

Background:

  • Survival outcomes for patients with liver disease and intracranial hemorrhage (ICH) are not well-documented.
  • Liver disease, particularly end-stage liver disease (ESLD), presents unique challenges in managing ICH.

Purpose of the Study:

  • To investigate survival rates in patients with liver disease who develop ICH.
  • To compare survival between operative and nonoperative management in ESLD patients with ICH.
  • To assess survival for ESLD patients on the liver transplant waitlist who experience ICH.

Main Methods:

  • Retrospective chart review of patients with liver disease and ICH from March 2006 to February 2017.
  • Inclusion of patients evaluated by neurosurgery at a single academic medical center.
  • Primary outcome measured was patient survival.

Main Results:

  • Overall survival was 22% for 29 patients with liver disease and ICH.
  • No significant survival difference was observed between operative and nonoperative management in 33 ESLD patients.
  • Survival was 14% for 7 ESLD patients on the liver transplant waitlist who suffered an in-hospital ICH.

Conclusions:

  • Intracranial hemorrhage in patients with liver disease is associated with a very poor prognosis.
  • The survival benefit of surgical hematoma evacuation in ESLD patients with ICH remains unclear.
Abstract

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