Abstract
Background: Hemorrhagic transformation (HT) is a frequent, often asymptomatic event that occurs after acute ischemic stroke (AIS). Liver fibrosis, usually subclinical, is common and crucial in the development of liver disease. We aimed to investigate the association between liver fibrosis and HT in patients with AIS.Methods: We performed a single-center and retrospective study. A total of 185 consecutive participants with HT and 199 age- and sex-matched stroke patients without HT were enrolled in this study. We calculated one validated fibrosis index—Fibrosis-4 (FIB-4) score—to assess the extent of liver fibrosis. HT was detected by routine CT or MRI and was radiologically classified as hemorrhagic infarction type 1 or 2 or parenchymal hematoma type 1 or 2. HT was also classified into asymptomatic or symptomatic. We used logistic regression models adjusted for previously established risk factors to assess the risks for HT.Results: The median FIB-4 score was significantly higher among patients who developed HT than among those without HT, whereas standard hepatic assays were largely normal. Patients were assigned to groups of high FIB-4 score and low FIB-4 score based on the optimal cutoff value. Compared with the subjects in the low-FIB-4-score group, incidence of HT for the high-FIB-4-score group was significantly higher. After adjustment for potential confounders, the patients with high FIB-4 score had 3.461-fold risk of HT in AIS compared to the patients with low FIB-4 score [odds ratio, 3.461 (95% CI, 1.404–8.531)].Conclusion: Liver fibrosis, measured by FIB-4 score, was independently associated with the risk of HT in AIS patients.
Highlights
Liver diseases could increase the risk of cardiovascular disease and lead to worse hospital discharge disposition and higher in-hospital mortality after stroke [1,2,3]
A recent study showed liver fibrosis, not simple steatosis, is a strong predictor of long-term mortality in the ischemic stroke population [7]. These studies highlight a possible relevance between advanced liver diseases and poor stroke outcomes, it is still unsure if these findings can apply to subclinical liver disease
The optimal cutoff value for the FIB-4 score determined by the receiver operating characteristic (ROC) curve was 2.68 with a sensitivity of 41.1% and specificity of 84.4% (Figure 1)
Summary
Liver diseases could increase the risk of cardiovascular disease and lead to worse hospital discharge disposition and higher in-hospital mortality after stroke [1,2,3]. A recent study showed liver fibrosis, not simple steatosis, is a strong predictor of long-term mortality in the ischemic stroke population [7]. These studies highlight a possible relevance between advanced liver diseases and poor stroke outcomes, it is still unsure if these findings can apply to subclinical liver disease. The presence and severity of liver fibrosis can predict cardiovascular mortality in patients with chronic liver disease as well as the risk of ischemic stroke [11, 12] and are associated with the outcomes after primary intracerebral hemorrhage (ICH) according to previous studies [13]. We aimed to investigate the association between liver fibrosis and HT in patients with AIS
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