Mo1026 Protein Calorie Malnutrition Predicts Acute Kidney Injury and Mortality in Cirrhotics: Analysis of the National Inpatient Sample

Abstract

Background: Atrial fibrillation (AF) predisposes non-cirrhotic patients to ischemic stroke and requires anticoagulant therapy for prevention. Traditionally, cirrhosis is considered to be a coagulopathic state and may be associated with increased or normal coagulability. The risk of ischemic stroke amongst those with atrial fibrillation and the associated risk scores for predicting ischemic scores are not well studied. We evaluated the risk of ischemic stroke among cirrhotics relative to non-cirrhotics with atrial fibrillation in national inpatient sample (NIS). Methods: A weighted sample of NIS for the year 2008 was analyzed. The risk of stroke associated with cirrhosis, adjusted for demographic and relevant risk factors, was estimated. Using STATA software, among patients with AF, we estimated the risk of cirrhosis with ischemic stroke relative to non-cirrhotic patients using weighted multivariate analysis while adjusting for other risk factors. We also calculated the CHADVasc scores among the sample population. Covariates of interest were characterized using ICD-9 CM codes. Results: The incidence of total stroke (ischemic and hemorrhagic) was significantly lower in cirrhotics when compared to non-cirrhotics. In individuals with AF the risk of ischemic stroke matched by risk factors for stroke demonstrated a lower incidence of ischemic stroke among patients with cirrhosis than non-cirrhotic controls. Multivariate analysis revealed 75% lower risk for stroke among cirrhotic patients with AF than non-cirrhotic AF patients (Odds ratio: 0.24; 95% [CI: 0.12 0.49]). The risk of ischemic stroke was lower among cirrhotics with AF for the same CHADVasc scores amongst non-cirrhotics. However, no difference in the risk of stroke was observed in cirrhotics with AF than non-cirrhotic AF patients with respect to hemorrhagic stroke (Odds ratio: 0.24; 95% CI: 0.0.3 1.7). The detailed analysis is described in the table. Conclusions: Cirrhotics appears to have a protective effect against ischemic stroke with or without AF. The incidence of hemorrhagic stroke was found to be lower in cirrhotics in general but this effect was not seen among those with AF. The risk of stroke amongst cirrhotics with AF is lower than what is predicted by CHADSVasc. Table showing the incidence of Ischemic stroke among cirrhotic and non-cirrhotic patients with atrial fibrillation