Abstract TP444: Liver Fibrosis is Associated With Hematoma Expansion and 90-Day Mortality in Primary Intracerebral Hemorrhage

Abstract

Introduction: Liver disease is associated with inflammation and coagulopathy. We hypothesized that liver fibrosis, a frequently subclinical precursor of cirrhosis, is associated with outcomes in intracerebral hemorrhage (ICH). Methods: We performed a retrospective cohort study using the Virtual International Stroke Trials Archive - ICH database. We included adult patients with primary ICH who presented within 24 hours of symptom onset. Patients with alcohol abuse and known liver disease were excluded. The exposure variables were three validated fibrosis indices calculated at the time of admission: the Aspartate aminotransferase Platelet Ratio Index (APRI), the Non-alcoholic Fatty Liver Disease Fibrosis Score (NFS), and the Fibrosis-4 (Fib-4) score. Our outcomes were hematoma expansion (HE) over 96 hours, perihematomal edema expansion, 90-day mortality, and 90-day disability (modified Rankin Scale scores 4-6). Multiple logistic regression models assessing the relationship between each 1.0 unit change in fibrosis indices and outcomes were adjusted for age, baseline ICH volume, Glasgow Coma Scale, location, intraventricular hemorrhage, and use of antithrombotic drugs. Patients with antithrombotic use and thrombocytopenia were excluded in sensitivity analyses. Results: Of 588 patients with ICH, mean age was 66 years (SD, 12), and mean baseline hematoma volume was 22.8 milliliters (SD, 21.6). Antithrombotic use was noted in 165 patients (28%). The mean APRI, NFS, and FIB-4 values were 0.4 (SD, 0.4), -0.8 (SD, 1.3), and 1.9 (SD, 1.4), respectively; the means reflect intermediate probabilities of fibrosis. HE was seen in 212 patients (36%). After adjusting, APRI was associated with HE (OR 2.00; 95% CI 1.09-3.67) and 90-day mortality (OR 1.75; 95% CI 1.04-2.97). NFS was also associated with HE (OR 1.20; 95% CI 1.04-1.46) and mortality (OR 1.34; 95% CI 1.02-1.75). Similarly, FIB-4 was associated with HE (OR 1.28; 95% CI 1.05-1.56) and mortality (OR 1.9; 95% CI 1.04-1.60). Indices were not associated with perihematomal edema expansion or 90-day disability. Sensitivity analysis results were similar. Conclusion: Liver fibrosis may be associated with HE and 90-day mortality after ICH. The implications of liver fibrosis for ICH warrant further investigation.