Association between nonalcoholic fatty liver disease and acute ischemic stroke severity and outcome

Abstract

AIM:To evaluate the association of nonalcoholic fatty liver disease (NAFLD) with acute ischemic stroke severity and in-hospital outcome. METHODS:We prospectively studied all patients who were admitted in our Department with acute ischemic stroke between September 2010 and August 2012 (n = 415; 39.5% males, mean age 78.8 ± 6.6 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS) score at admission. NALFD was defined as serum alanine aminotransferase and/or aspartate aminotransferase levels above the upper limit of normal in the absence of other causes of elevated aminotransferases levels [chronic hepatitis B or C, drug toxicity, increased alcohol consumption (> 21 and > 14 drinks per week in men and women, respectively), cholestatic diseases or rhabdomyolysis]. The outcome was assessed with the modified Rankin scale (mRS) score at discharge and in-hospital mortality. Adverse outcome was defined as mRS score at discharge ≥ 2. Dependency at discharge was defined as mRS score between 2 to 5. RESULTS:NAFLD was present in 7.7% of the study population. Patients with NAFLD had lower serum high-density lipoprotein cholesterol and higher triglyceride levels than patients without NAFLD (P < 0.05 for both comparisons). Demographic data, the prevalence of other cardiovascular risk factors and the prevalence of established CVD did not differ between the two groups. At admission, the NIHSS score did not differ between patients with and without NAFLD (6.3 ± 6.4 and 8.8 ± 9.6, respectively; P = NS). At discharge, the mRS score did not differ between the two groups (1.9 ± 2.2 and 2.6 ± 2.2 in patients with and without NAFLD, respectively; P = NS). Rates of dependency at discharge were also similar in patients with and without NAFLD (36.8% and 55.0%, respectively; P = NS) as were the rates of adverse outcome (42.9% and 58.6%, respectively; P = NS). In-hospital mortality rates also did not differ between the 2 groups (8.0% and 7.0% in patients with and without NAFLD, respectively; P = NS). CONCLUSION:The presence of NAFLD in patients admitted for acute ischemic stroke does not appear to be associated with more severe stroke or with worse in-hospital outcome.

Discharge Disposition After Stroke in Patients With Liver Disease

“…8 In contrast to our cohort, this study was a single-center cohort of patients. 8 With respect to ischemic stroke outcomes, unlike a limited analysis of mono-ethnic patients with non-alcoholic fatty liver disease, 9 our findings suggest that liver disease is also associated with a worse outcome after ischemic stroke.…”

Non‐alcoholic fatty liver disease is associated with stroke severity and progression of brainstem infarctions

“…. A small number of studies have investigated the risk of cerebrovascular disease among participants with ultrasound‐diagnosed NAFLD . However, larger studies with longer follow‐up times are needed.…”

“…One study concluded that NAFLD was associated with more severe strokes and poorer outcomes [14]. However, many studies have shown that this association is diminished or loses statistical significance after adjustment for traditional vascular risk factors [15,16]. The association between NAFLD and BSIs was not reported in those studies.…”

Lipid-lowering agents in the management of nonalcoholic fatty liver disease

“…Several cross-sectional studies showed that patients with NAFLD have a greater atherosclerotic burden and a higher prevalence of cardiovascular disease (CVD) [7][8][9] . Moreover, observational studies suggest that patients with NAFLD have increased cardiovascular risk and that CVD is the leading cause of death in this population [10][11][12][13] . Since NAFLD and CVD have many common risk factors (e.g., abdominal obesity, type 2 diabetes mellitus (T2DM), insulin resistance, inflammation and oxidative stress), the increased CVD risk in patients with NAFLD might be partly explained by their shared pathogenesis [14][15][16][17] .…”