Association between Liver Disease and Intracranial Hemorrhage

Parikh, Neal S; Navi, Babak B.; Kumar, Sonal; Kamel, Hooman

doi:10.1016/j.jstrokecerebrovasdis.2015.11.005

Cited by 29 publications

(28 citation statements)

References 27 publications

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“…In our study, the inpatient mortality rate was higher in patients with liver disease. Similar findings were noted by Parikh et al 13 were liver disease was associated with an increased risk of ICH (HR: 1.8). Not unexpectedly, the mortality rate is higher in patients with underlying coagulopathy with use of oral anticoagulants a not uncommon association.…”

Section: Discussionsupporting

confidence: 89%

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample

Javalkar

Kuybu

Davis

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Background: To use a nationwide database of hospital admissions to assess for trends in inpatient mortality from acute spontaneous intracerebral hemorrhage as well as associated potentially contributing factors. Methods: Adults with intracerebral hemorrhage in the US National Inpatient Sample database from 2012 to 2015 were included in this study. We assessed for mortality rate as well as potential impact of various comorbidities and demographic factors such as ethnicity and median house hold income on inpatient mortality rate. Results: A total of 47,700 patients were identified with a mean age of 68 years. The overall mortality rate was 24%. Hypertension was the commonest comorbidity (84%) followed by diabetes mellitus (28%). Positive associated factors for mortality rate were coagulopathy (

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Section: Discussionsupporting

confidence: 89%

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample

Javalkar

Kuybu

Davis

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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“…1 A similar relationship with ischemic stroke has not been observed. 2 However, liver disease, particularly cirrhotic liver disease, is complicated by an imbalanced coagulopathy with implications for both hemorrhagic and thrombotic processes.…”

mentioning

confidence: 82%

Discharge Disposition After Stroke in Patients With Liver Disease

Parikh

Merkler

Schneider

et al. 2017

Stroke

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Background & Purpose Liver disease is associated with both hemorrhagic and thrombotic processes, including an elevated risk of intracranial hemorrhage (ICH). We sought to assess the relationship between liver disease and outcomes after stroke, as measured by discharge disposition. Methods Using administrative claims data, we identified a cohort of patients hospitalized with stroke in California, Florida, and New York from 2005 to 2013. The predictor variable was liver disease. All diagnoses were defined using validated diagnosis codes. Ordinal logistic regression was used to analyze the association between liver disease and worsening discharge disposition: home, nursing/rehabilitation facility, or death. Secondarily, multiple logistic regression was used to analyze the association between liver disease and in-hospital mortality. Models were adjusted for demographics, vascular risk factors, and comorbidities. Results We identified 121,428 patients with ICH and 703,918 with ischemic stroke. Liver disease was documented in 13,584 patients (1.7%). Liver disease was associated with worse discharge disposition after both ICH (global odds ratio [OR], 1.28; 95% confidence interval [CI], 1.19–1.38) and ischemic stroke (OR, 1.23; 95% CI, 1.17–1.29). Similarly, liver disease was associated with in-hospital death after both ICH (OR, 1.33; 95% CI, 1.23–1.44) and ischemic stroke (OR, 1.60; 95% CI, 1.51–1.71). Conclusions Liver disease was associated with worse hospital discharge disposition and in-hospital mortality after stroke, suggesting worse functional outcomes.

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“…Kuo et al evaluated liver disease patients with CHA 2 DS 2 ‐VASc score ≥2 in the setting of AF and showed a reduction in ischemic stroke events in patients treated with warfarin compared with those with and without antiplatelet therapy, notably without increased intracranial hemorrhage 16. However, an increased risk of hemorrhagic stroke and intracranial hemorrhage has been reported in patients with cirrhosis as compared with those without,17, 18 and in 1 study was reported to be higher than ischemic stroke risk 19. A tailored strategy has been proposed and includes anticoagulation in the setting of less‐severe liver disease, while refraining from anticoagulation in more severe cirrhotic patients with AF 20.…”

Section: Discussionmentioning

confidence: 99%

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

Huang

Dunipace

Sorg

et al. 2018

JAHA

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BackgroundImpact of liver disease on development of atrial fibrillation (AF) is unclear. The purpose of the study was to evaluate prevalence of AF in the setting of liver disease and whether increasing severity of liver disease, using Model for End‐Stage Liver Disease (MELD), is independently associated with increased risk of AF.Methods and ResultsRetrospective data analysis of 1727 patients with liver disease evaluated for liver transplantation between 2006 and 2015 was performed, and patient characteristics were analyzed from billing codes and review of medical records. Multivariable time‐dependent Cox proportional hazards model was performed to determine effect of increasing MELD score on risk of developing AF. Prevalence of AF was 11.2%. Incidence of AF at median follow‐up time of 1.04 years was 8.5%. Both prevalence and incidence of AF increased with increasing MELD scores. Prevalence of AF was 3.7%, 6.4%, 16.7%, and 20.2% corresponding with MELD quartiles 1 to 10, 11 to 20, 21 to 30, and >30, respectively. Compared with patients with MELD quartile 1 to 10, patients with MELD quartile of 11 to 20 had hazard ratio of 2.73 (confidence interval, 1.47–5.07), those in the MELD quartile of 21 to 30 had a hazard ratio of 5.17 (confidence interval, 2.65–10.09), and those with MELD values >30 had hazard ratio of 9.33 (confidence interval, 3.93–22.14) for development of new‐onset AF. Other significant variables associated with new‐onset AF were age, sleep apnea, valvular heart disease, hemodynamic instability, and reduced left ventricular ejection fraction <50% (hazard ratio, of 1.06, 2.17, 3.21, 2.00, and 2.44, respectively).ConclusionsPrevalence and incidence of AF in patients with liver disease is high. Severity of liver disease, as measured by MELD, is an important predictor of new‐onset AF. This novel finding suggests an interaction between inflammatory and neurohormonal changes in liver disease and pathogenesis of AF.

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Association between Liver Disease and Intracranial Hemorrhage

Cited by 29 publications

References 27 publications

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample

Discharge Disposition After Stroke in Patients With Liver Disease

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

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