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Liver Fibrosis-4 index indicates atrial fibrillation in acute ischemic stroke
Simon Fandler-Höfler1, Markus Kneihsl1, Rudolf E Stauber2
1Department of Neurology, Medical University of Graz, Graz, Austria.
Insights
Advanced liver fibrosis, indicated by the Fibrosis-4 (FIB-4) index, is independently linked to atrial fibrillation (AF) in ischemic stroke patients. This finding suggests FIB-4 may help identify stroke patients at higher risk for AF.
Area of Science:
- Cardiology
- Hepatology
- Neurology
Background:
- Non-alcoholic fatty liver disease and liver fibrosis are associated with cardiovascular disease.
- This association may increase the risk of atrial fibrillation (AF).
- The link between liver fibrosis and AF in ischemic stroke patients requires systematic investigation.
Purpose of the Study:
- To investigate the association between liver fibrosis and atrial fibrillation in ischemic stroke patients.
- To evaluate the predictive value of the Fibrosis-4 (FIB-4) index for AF in this cohort.
Main Methods:
- Prospective single-center study of consecutive ischemic stroke patients.
- Etiological workup including noninvasive liver fibrosis assessment using the FIB-4 index.
- Laboratory results analyzed from blood samples taken at admission.
Main Results:
- Advanced liver fibrosis (FIB-4 ≥ 2.67) was present in 22.2% of 414 patients.
- Patients with advanced fibrosis had significantly higher rates of AF (53.3% vs. 20.8%).
- The association between FIB-4 and AF remained significant after adjusting for established risk factors (OR 2.53).
Conclusions:
- Liver fibrosis, assessed by the FIB-4 index, is independently associated with AF in acute ischemic stroke patients.
- The FIB-4 index may serve as a valuable tool for identifying AF risk in stroke patients.
- Further research should explore incorporating FIB-4 into existing AF risk scores.
Background:
Non-alcoholic fatty liver disease and particularly liver fibrosis are related to cardiovascular disease and may indicate an increased risk for atrial fibrillation (AF), but this association has not yet been systematically investigated in a cohort of ischemic stroke patients.
Methods:
We analyzed data from a prospective single-center study enrolling all consecutive ischemic stroke patients admitted to our stroke unit over a 1-year period. All patients received a thorough etiological workup. For evaluation of liver fibrosis, we determined the Fibrosis-4 (FIB-4) index, a well-established noninvasive liver fibrosis test. Laboratory results were analyzed from a uniform blood sample taken at stroke unit admission.
Results:
Of 414 included patients (mean age 70.2 years, 57.7% male), FIB-4 indicated advanced liver fibrosis in 92 (22.2%). AF as the underlying stroke mechanism was present in 28.0% (large vessel disease: 25.6%, small vessel disease: 11.4%, cryptogenic: 29.2%). Patients with FIB-4 ≥ 2.67 had higher rates of AF (53.3% vs. 20.8%, p < 0.001), and this association remained significant after correction for established AF risk factors (odds ratio 2.53, 95% confidence interval 1.44-4.46, p = 0.001). FIB-4 was further associated with worse functional outcome 3 months (p < 0.001) and higher mortality 4 years post-stroke (p < 0.02), but these relationships were no longer present after correction for age and initial stroke severity. Moreover, FIB-4 was not associated with long-term recurrent vascular events.
Conclusions:
Liver fibrosis assessed by the FIB-4 index is independently associated with AF in acute ischemic stroke patients. Further studies should evaluate whether adding the FIB-4 index to AF risk scores increases their precision.
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