Liver Fibrosis may Increase mortality risk among in patients of Ischemic Stroke

GREECE: Hepatic fibrosis, as measured by the FIB-4 index, may contribute as a significant risk factor for in-hospital mortality among individuals hospitalized with acute ischemic stroke in addition to being related to more severe ischemic stroke, states a study published in the Journal of Clinical Medicine.

"An elevated incidence of cardiovascular events, including ischemic stroke, is linked to nonalcoholic fatty liver disease, especially when hepatic fibrosis is present. Hepatic fibrosis may or may not affect the intensity and course of an acute ischemic stroke," mentioned the authors.

The investigators aimed to assess the association between hepatic fibrosis and the severity of acute ischemic stroke at admission and in-hospital prognosis.

They conducted a prospective analysis of all patients who suffered an acute ischemic stroke between September 2010 and February 2018 (n = 1107; 42.1% men; age 79.8 7.2 years). At admission, the National Institutes of Health Stroke Scale was used to determine the severity of the stroke (NIHSS). NIHSS 21 was the cutoff point for severe stroke. With the Fibrosis-4 index, the degree of hepatic fibrosis was assessed (FIB-4). A modified Rankin Scale between 2 and 5 was used to measure dependency at discharge, and in-hospital mortality was used to measure the outcome.

Key highlights of the research:

• Patients who had experienced a severe stroke showed a higher FIB-4 index than those who had not (2.7± 1.7 and 2.3 ± 1.4, respectively).
• Age (relative risk (RR) 1.064, 95% confidence interval (CI) 1.030-1.100, p < 0.001), female gender (RR 1.723, 95% CI 1.100-2.698, p = 0.012), atrial fibrillation (RR 1.869, 95% CI 1.234-2.831, p = 0.002), diastolic blood pressure (DBP) (RR 1.019, 95% CI 1.006-1.033, p = 0.001), and the FIB-4 index (RR 1.130, 95% CI 1.007-1.268, p = 0.022) were the independent risk predictors for severe IS.
• 64.2% of individuals were dependent at discharge.
• At the time of discharge, there was no difference in the FIB-4 index among subjects who were dependent versus those who were independent (2.3 ±1.5 and 2.1± 1.2, respectively; p = 0.061).
• 9.8% of patients passed away while they were in the hospital.
• Compared to those who were discharged, individuals who passed away in the hospital had a higher FIB-4 index (2.9± 1.8 vs. 2.3± 1.4, respectively).
• DBP, serum glucose levels, serum triglyceride levels, NIHSS, and the FIB-4 index were the independent risk factors for in-hospital mortality.

The authors concluded that the risk of acute ischemic stroke is more severe, and having a worse outcome is increased by hepatic fibrosis.

REFERENCE

Ztriva, Eleftheria, et al. "Hepatic Fibrosis Is a Risk Factor for Greater Severity and Worse Outcome of Acute Ischemic Stroke." Journal of Clinical Medicine, vol. 11, no. 17, 2022.