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Liver Fibrosis Indices and Outcomes After Primary Intracerebral Hemorrhage.

TitleLiver Fibrosis Indices and Outcomes After Primary Intracerebral Hemorrhage.
Publication TypeJournal Article
Year of Publication2020
AuthorsParikh NS, Kamel H, Navi BB, Iadecola C, Merkler AE, Jesudian A, Dawson J, Falcone GJ, Sheth KN, Roh DJ, Elkind MSV, Hanley DF, Ziai WC, Murthy SB
Corporate AuthorsVISTA-ICH Collaborators
JournalStroke
Volume51
Issue3
Pagination830-837
Date Published2020 Mar
ISSN1524-4628
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.

DOI10.1161/STROKEAHA.119.028161
Alternate JournalStroke
PubMed ID31906832
PubMed Central IDPMC7048169
Grant ListR01 NR018335 / NR / NINR NIH HHS / United States
U24 NS107136 / NS / NINDS NIH HHS / United States
UL1 TR001863 / TR / NCATS NIH HHS / United States
T32 NS007153 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
U01 NS080824 / NS / NINDS NIH HHS / United States
U24 TR001609 / TR / NCATS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
U24 NS107215 / NS / NINDS NIH HHS / United States
R01 NS029993 / NS / NINDS NIH HHS / United States
R01 NS095441 / NS / NINDS NIH HHS / United States
K76 AG059992 / AG / NIA NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
U01 NS106513 / NS / NINDS NIH HHS / United States
K23 NS105948 / NS / NINDS NIH HHS / United States

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