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Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study
Zijie Wang1, Zhitao Gong2, Jianshang Wen3
1Department of Neurology The Second Affiliated Hospital of Anhui Medical University Hefei China.
Insights
Advanced liver fibrosis significantly increases the risk of stroke and death, particularly intracerebral and subarachnoid hemorrhage. Noninvasive fibrosis scores can identify high-risk individuals for primary prevention.
Area of Science:
- Cardiology
- Hepatology
- Neurology
Background:
- Established link between liver conditions and cardiovascular diseases.
- Uncertainty regarding liver fibrosis's specific contribution to major stroke types (ischemic, intracerebral hemorrhage, subarachnoid hemorrhage) at a population level.
Purpose of the Study:
- To investigate the association between liver fibrosis and the risk of major stroke types, stroke-related death, and all-cause death.
- To evaluate the utility of noninvasive liver fibrosis indices in identifying individuals at elevated risk for stroke and death.
Main Methods:
- Prospective cohort study using UK Biobank data.
- Inclusion of participants without prior stroke or coronary heart disease.
- Identification of advanced liver fibrosis using Fibrosis-4 index (>2.67) or AST/Platelet Ratio Index (≥1.0).
- Multivariable Cox proportional hazard regression analyses to estimate hazard ratios for stroke incidence and mortality.
Main Results:
- Advanced liver fibrosis was associated with increased risk of ischemic stroke (HR, 1.94), intracerebral hemorrhage (HR, 2.14), subarachnoid hemorrhage (HR, 1.90), stroke-related death (HR, 2.20), and all-cause death (HR, 2.59).
- The AST/Platelet Ratio Index indicated a higher risk for intracerebral hemorrhage (HR, 3.76) and subarachnoid hemorrhage (HR, 3.05) compared to ischemic stroke (HR, 1.58).
- Nonlinear associations were observed between fibrosis indices and stroke/all-cause death risk.
Conclusions:
- Liver fibrosis is a significant risk factor for incident stroke and mortality in individuals without prior cardiovascular events.
- The risk is particularly elevated for intracerebral hemorrhage and subarachnoid hemorrhage.
- Noninvasive liver fibrosis markers can aid in identifying individuals at high risk for stroke and death in primary prevention settings.
Background:
There is a well-established relationship between liver conditions and cardiovascular diseases. However, uncertainty persists regarding the contribution of liver fibrosis to major stroke types including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage at the population level.
Methods:
In this large prospective cohort study, participants without previous stroke or coronary heart disease at baseline from the UK Biobank were included. We identified participants at high probability of advanced liver fibrosis using the Fibrosis-4 index >2.67 or aspartate aminotransferase to platelet ratio index ≥1.0. Multivariable Cox proportional hazard regression analyses were conducted to estimate hazard ratios (HRs) for liver fibrosis with the incidence of major stroke types, stroke-related death, and all-cause death.
Results:
Among 379 953 participants (mean age, 56.2 [SD, 8.1] years; 44.6% men), 7396 (1.9%) had a Fibrosis-4 index >2.67 at baseline. During a median follow-up of 12.75 (interquartile range, 12.03-13.48) years, 7143 (1.9%) incident stroke cases were documented. Advanced liver fibrosis assessed by the Fibrosis-4 index was associated with an increased risk of ischemic stroke (HR, 1.94 [95% CI, 1.70-2.22]), intracerebral hemorrhage (HR, 2.14 [95% CI, 1.63-2.81]), subarachnoid hemorrhage (HR, 1.90 [95% CI, 1.27-2.84), stroke-related death (HR, 2.20 [95% CI, 1.73-2.80]), and all-cause death (HR, 2.59 [95% CI, 2.46-2.73]). Using the aspartate aminotransferase to platelet ratio index as an alternative score, liver fibrosis was correlated with magnified risk of intracerebral hemorrhage (HR, 3.76 [95% CI, 2.38-5.93]) and subarachnoid hemorrhage (HR, 3.05 [95% CI, 1.51-6.13]) compared with ischemic stroke (HR, 1.58 [95% CI, 1.17-2.14]). Restricted cubic spline analysis showed nonlinear associations of the Fibrosis-4 index and aspartate aminotransferase to platelet ratio index with stroke incidence and all-cause death.
Conclusions:
Liver fibrosis is associated with increased risk of incident stroke and death among people without previous stroke or cardiovascular events, with particularly greater risk of intracerebral hemorrhage and subarachnoid hemorrhage. Noninvasive indices of liver fibrosis may serve as an easily accessible marker to detect individuals facing elevated risk of stroke and death in the primary prevention settings.
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