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Published on: July 3, 2014
Liver Fibrosis Indices and Outcomes After Primary Intracerebral Hemorrhage
Neal S Parikh1, Hooman Kamel1, Babak B Navi1
1From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (N.S.P., H.K., B.B.N., C.I., A.E.M., S.B.M.), Weill Cornell Medicine, New York, NY.
Insights
Subclinical liver fibrosis, indicated by two specific indices, is linked to larger hematoma volume, increased expansion, and higher mortality in intracerebral hemorrhage patients. These findings emerge despite normal liver function tests, highlighting fibrosis as a potential risk factor.
Area of Science:
- Neurology
- Hepatology
- Biostatistics
Background:
- Overt cirrhosis increases hemorrhagic stroke risk and worsens outcomes.
- Subclinical liver disease, specifically fibrosis, may impact intracerebral hemorrhage (ICH) patient prognosis.
- Investigating liver fibrosis in ICH is crucial for understanding disease mechanisms and improving patient care.
Purpose of the Study:
- To determine if subclinical liver fibrosis is associated with clinical and radiological outcomes in primary ICH patients.
- To assess the relationship between fibrosis indices and hematoma volume, expansion, and mortality.
- To evaluate the predictive value of fibrosis scores in ICH management.
Main Methods:
- Retrospective cohort study using the Virtual International Stroke Trials Archive-Intracerebral Hemorrhage database.
- Inclusion of adult patients with primary ICH presenting within 6 hours of symptom onset.
- Calculation of Aspartate Aminotransferase-Platelet Ratio Index, Fibrosis-4 score, and Nonalcoholic Fatty Liver Disease Fibrosis Score; regression analysis for outcomes including hematoma volume, expansion, and 90-day mortality.
Main Results:
- Among 432 ICH patients, fibrosis indices suggested intermediate fibrosis despite normal liver assays.
- Aspartate Aminotransferase-Platelet Ratio Index and Fibrosis-4 score were significantly associated with increased hematoma volume and expansion.
- Both indices were also linked to higher 90-day mortality, while Nonalcoholic Fatty Liver Disease Fibrosis Score showed no association.
Conclusions:
- Two liver fibrosis indices (AST-Platelet Ratio Index and Fibrosis-4) predict worse outcomes in ICH patients with normal liver chemistries.
- Liver fibrosis is an independent risk factor for hematoma volume, expansion, and mortality post-ICH.
- These findings suggest fibrosis assessment could aid in stratifying ICH patient risk.
Abstract:
Background and Purpose- Cirrhosis-clinically overt, advanced liver disease-is associated with an increased risk of hemorrhagic stroke and poor stroke outcomes. We sought to investigate whether subclinical liver disease, specifically liver fibrosis, is associated with clinical and radiological outcomes in patients with primary intracerebral hemorrhage. Methods- We performed a retrospective cohort study using data from the Virtual International Stroke Trials Archive-Intracerebral Hemorrhage. We included adult patients with primary intracerebral hemorrhage presenting within 6 hours of symptom onset. We calculated 3 validated fibrosis indices-Aspartate Aminotransferase-Platelet Ratio Index, Fibrosis-4 score, and Nonalcoholic Fatty Liver Disease Fibrosis Score-and modeled them as continuous exposure variables. Primary outcomes were admission hematoma volume and hematoma expansion. Secondary outcomes were mortality, and the composite of major disability or death, at 90 days. We used linear and logistic regression models adjusted for previously established risk factors. Results- Among 432 patients with intracerebral hemorrhage, the mean Aspartate Aminotransferase-Platelet Ratio Index, Fibrosis-4, and Nonalcoholic Fatty Liver Disease Fibrosis Score values on admission reflected intermediate probabilities of fibrosis, whereas standard hepatic assays and coagulation parameters were largely normal. After adjusting for potential confounders, Aspartate Aminotransferase-Platelet Ratio Index was associated with hematoma volume (β, 0.20 [95% CI, 0.04-0.36]), hematoma expansion (odds ratio, 1.6 [95% CI, 1.1-2.3]), and mortality (odds ratio, 1.8 [95% CI, 1.1-2.7]). Fibrosis-4 was also associated with hematoma volume (β, 0.27 [95% CI, 0.07-0.47]), hematoma expansion (odds ratio, 1.9 [95% CI, 1.2-3.0]), and mortality (odds ratio, 2.0 [95% CI, 1.1-3.6]). Nonalcoholic Fatty Liver Disease Fibrosis Score was not associated with any outcome. Indices were not associated with the composite of major disability or death. Conclusions- In patients with largely normal liver chemistries, 2 liver fibrosis indices were associated with admission hematoma volume, hematoma expansion, and mortality after intracerebral hemorrhage.
