Liver fibrosis indices and outcomes after primary intracerebral hemorrhage

Parikh, N. S. et al. (2020) Liver fibrosis indices and outcomes after primary intracerebral hemorrhage. Stroke, 51(3), pp. 830-837. (doi: 10.1161/STROKEAHA.119.028161) (PMID:31906832)

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.

• Item Type: Articles
• Additional Information: Dr Parikh was supported by National Institutes of Health (NIH; T32NS07153, Principal Investigator: Dr Elkind). Dr Kamel is supported by NIH (R01NS097443, U01NS095869) and Michael Goldberg Research Fund. Dr Navi is supported by NIH (K23NS091395), Florence Gould Endowment for Discovery in Stroke. Dr Iadecola is supported by NIH (R01NS34179, R37-NS089323, R01-NS100447, 1R01-NS095441, R01-NS/HL37853). Dr Merkler is supported by American Heart Association (AHA; 18CDA34110419), Leon Levy Foundation. Dr Jesudian is supported by Society of Interventional Radiology Foundation. Dr Falcone is funded by NIH (K76AG059992), AHA (18IDDG34280056), Yale Pepper Scholar Award (P30AG021342), Neurocritical Care Society Research Fellowship. Dr Sheth is supported by NIH (U01NS106513, U24NS107215, U24NS107136, R01NR018335), AHA (17CSA33550004). Dr Elkind is supported by NIH (R01NS029993, U01NS095869). Dr Hanley is supported by NIH (1U01NS080824, U24TR001609). Dr Ziai is supported by NIH (1U01NS080824). Dr Murthy is supported by NIH (K23NS105948), Leon Levy Foundation.
• Keywords: aspartate aminotransferase, cerebral hemorrhage, fibrosis, hematoma, risk factors.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Dawson, Professor Jesse
• Authors: Parikh, N. S., Kamel, H., Navi, B. B., Iadecola, C., Merkler, A. E., Jesudian, A., Dawson, J., Falcone, G. J., Sheth, K. N., Roh, D. J., Elkind, M. S.V., Hanley, D. F., Ziai, W. C., and Murthy, S. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Copyright Holders: Copyright © 2020 American Heart Association, Inc.
• First Published: First published in Stroke 51(3):830-837
• Publisher Policy: Reproduced in accordance with the publisher copyright policy