Liver fibrosis indices associated with substantial hematoma expansion in Chinese patients with primary intracerebral hemorrhage

Huan Wang,Junfeng Liu,Zilong Hao,Ming Liu,Jiongxing Wu,Wendan Tao,Shihong Zhang,Bo Wu,Deren Wang,Xue Yang

doi:10.1186/s12883-021-02494-0

Abstract

BackgroundWhether liver fibrosis is associated with increased risk for substantial hematoma expansion (HE) after intracerebral hemorrhage (ICH) is still uncertain. We evaluated the association between various liver fibrosis indices and substantial HE in a Chinese population with primary ICH.MethodsPrimary ICH patients admitted to West China Hospital within 24 h of onset between January 2015 and June 2018 were consecutively enrolled. Six liver fibrosis indices were calculated, including aspartate aminotransferase (AST)-platelet ratio index (APRI), AST/alanine aminotransferase ratio-platelet ratio index (AARPRI), fibrosis-4 (FIB-4), modified fibrosis-4 (mFIB-4), fibrosis quotient (FibroQ) and Forns index. Substantial HE was defined as an increase of more than 33% or 6 mL from baseline ICH volume. The association of each fibrosis index with substantial HE was analyzed using binary logistic regression.ResultsOf 436 patients enrolled, about 85% showed largely normal results on standard hepatic assays and coagulation parameters. Substantial HE occurred in 115 (26.4%) patients. After adjustment, AARPRI (OR 1.26, 95% CI 1.00-1.57) and FIB-4 (OR 1.15, 95% CI 1.02-1.30) were independently associated with substantial HE in ICH patients within 24 h of onset, respectively. In ICH patients within 6 h of onset, each of the following indices was independently associated with substantial HE: APRI (OR 2.64, 95% CI 1.30-5,36), AARPRI (OR 1.55, 95% CI 1.09-2.21), FIB-4 (OR 1.35, 95% CI 1.08-1.68), mFIB-4 (OR 1.09, 95% CI 1.01-1.18), FibroQ (OR 1.08, 95% CI 1.00-1.16) and Forns index (OR 1.37, 95% CI 1.10-1.69).ConclusionsLiver fibrosis indices are independently associated with higher risk of substantial HE in Chinese patients with primary ICH, which suggesting that subclinical liver fibrosis could be routinely assessed in such patients to identify those at high risk of substantial HE.

Highlights

Intracerebral hemorrhage (ICH) accounts for 10% to 15% of all strokes, and causes up to 50% of all strokerelated mortality [1,2,3]
Patients were excluded if they met any of the following criteria: (1) were < 18 years old; (2) had a secondary cause of intracerebral hemorrhage (ICH), or primary intraventricular hemorrhage (IVH), or primary subarachnoid hemorrhage (SAH); (3) were on anticoagulant therapy before admission; (4) had severe liver disease or clinical syndrome associated with liver disease; (5) had undergone surgical evacuation; or (6) were lacking laboratory data of hepatic assays or coagulation parameters, which were tested routinely in most of patients
Since hematoma volume on admission may affect the association between liver fibrosis indices and substantial hematoma expansion (HE), we considered two models: Model 1 and Model 2, which contained the same variables as Model 1 in addition to baseline hematoma volume

Summary

Introduction

Intracerebral hemorrhage (ICH) accounts for 10% to 15% of all strokes, and causes up to 50% of all strokerelated mortality [1,2,3]. Several noninvasive markers have been reported to predict liver fibrosis: AST/ALT ratio (AAR), AST–platelet ratio index (APRI), AAR/platelet ratio index (AARPRI), fibrosis-4 (FIB-4), modified fibrosis-4 (mFIB-4), fibrosis quotient (FibroQ) and the Forns index [15,16,17] These liver fibrosis indices allow simple, inexpensive, straightforward assessment of liver fibrosis, including in patients with viral hepatitis, non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD) [15,16,17,18,19,20,21]. Whether liver fibrosis is associated with increased risk for substantial hematoma expansion (HE) after intracerebral hemorrhage (ICH) is still uncertain.

Objectives

Methods

Results

Conclusion