Association between Liver Disease and Intracranial Hemorrhage.

TitleAssociation between Liver Disease and Intracranial Hemorrhage.
Publication TypeJournal Article
Year of Publication2016
AuthorsParikh NS, Navi BB, Kumar S, Kamel H
JournalJ Stroke Cerebrovasc Dis
Date Published2016 Mar
KeywordsAdult, Aged, Cohort Studies, Community Health Planning, Female, Humans, Intracranial Hemorrhages, Kaplan-Meier Estimate, Liver Diseases, Male, Middle Aged, Proportional Hazards Models, Risk Factors

BACKGROUND: Liver disease is common and associated with clinical and laboratory evidence of coagulopathy. The association between liver disease and intracranial hemorrhage (ICH) remains unclear. Our aim was to assess whether liver disease increases the risk of ICH.

METHODS: We performed a retrospective cohort study based on administrative claims data from California, Florida, and New York acute care hospitals from 2005 through 2011. Of a random 5% sample, we included patients discharged from the emergency department or hospital after a diagnosis of liver disease and compared them to patients without liver disease. Patients with cirrhotic liver disease were additionally analyzed separately. Kaplan-Meier survival statistics were used to calculate cumulative rates of incident ICH, and Cox proportional hazard analysis was used to adjust for demographic characteristics, vascular disease, and Elixhauser comorbidities. Multiple models tested the robustness of our results.

RESULTS: Among 1,909,816 patients with a mean follow-up period of 4.1 (±1.8) years, the cumulative rate of ICH after a diagnosis of liver disease was 1.70% (95% confidence interval [CI], 1.55%-1.87%) compared to .40% (95% CI, .39%-.41%) in patients without liver disease (P <.001 by the log-rank test). Liver disease remained associated with an increased hazard of ICH after adjustment for demographic characteristics and vascular risk factors (hazard ratio [HR], 1.8; 95% CI, 1.6-2.0). This was attenuated in models additionally adjusted for general comorbidities (HR, 1.3; 95% CI, 1.2-1.5).

CONCLUSIONS: There is a modest, independent association between liver disease and the risk of ICH.

Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID26679070
PubMed Central IDPMC4779717
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
K23NS082367 / NS / NINDS NIH HHS / United States
K23NS091395 / NS / NINDS NIH HHS / United States

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