Intracerebral Hemorrhage in Patients With Chronic Liver Disease

Hoya, Katsumi; Tanaka, Yoshihiro; Uchida, Takanori; Takano, Issei; Nagaishi, Masaya; Kowata, Kazuma; Hyodo, Akio

doi:10.2176/nmc.52.181

Cited by 19 publications

(13 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 95%

“…Poor outcomes after ICH in this population may in part be due to increased hematoma size and/or expansion in patients with liver disease. 10, 11 Alternatively, patients with liver disease may be otherwise prone to decompensation due to non-neurological conditions, 8 such as alcohol withdrawal or frailty. Last, possible interactions between liver disease and stroke treatment may play a role directly or limit provision of therapies.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Discharge Disposition After Stroke in Patients With Liver Disease

Parikh

Merkler

Schneider

et al. 2017

Stroke

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“…While the clinical characteristics of ICH in cirrhosis have been described (7, 8), the two available studies on ICH risk in liver disease, including cirrhosis, produced conflicting results (9, 10). Further, a recent study, though not designed to assess the degree of ICH risk associated with liver disease, revealed ICH to be an infrequent cause of altered mental status in cirrhotic patients (11).…”

Section: Introductionmentioning

confidence: 99%

Association between Liver Disease and Intracranial Hemorrhage

Parikh

Navi

Kumar

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background Liver disease is common and associated with clinical and laboratory evidence of coagulopathy. The association between liver disease and intracranial hemorrhage remains unclear. Our aim was to assess whether liver disease increases the risk of intracranial hemorrhage. Methods We performed a retrospective cohort study based on administrative claims data from California, Florida and New York acute care hospitals from 2005 through 2011. Of a random 5% sample, we included patients discharged from the emergency department or hospital after a diagnosis of liver disease and compared them to patients without liver disease. Patients with cirrhotic liver disease were additionally analyzed separately. Kaplan-Meier survival statistics were used to calculate cumulative rates of incident intracranial hemorrhage, and Cox proportional hazard analysis was used to adjust for demographic characteristics, vascular disease and Elixhauser comorbidities. Multiple models tested the robustness of our results. Results Among 1,909,816 patients with a mean follow-up period of 4.1 (±1.8) years, the cumulative rate of intracranial hemorrhage after a diagnosis of liver disease was 1.70% (95% confidence interval [CI], 1.55–1.87%) compared to 0.40% (95% CI, 0.39–0.41%) in patients without liver disease (P < 0.001 by the log-rank test). Liver disease remained associated with an increased hazard of intracranial hemorrhage after adjustment for demographic characteristics and vascular risk factors (hazard ratio [HR], 1.8; 95% CI, 1.6–2.0). This was attenuated in models additionally adjusted for general comorbidities (HR, 1.3; 95% CI, 1.2–1.5). Conclusions There is a modest, independent association between liver disease and the risk of intracranial hemorrhage.

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“…But thrombocytopenia does not always require platelet transfusion. Hypertension was less frequent in patients with chronic liver disease and liver cirrhosis [7]. This may suggest that patients with liver dysfunction are more vulnerable to developing ICH than those without such background pathology.…”

Section: Discussionmentioning

confidence: 93%

Spontaneous intracerebral hemorrhage during left hemihepatectomy in a cirrhotic patient

2019

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Spontaneous intracerebral hemorrhage (sICH) is bleeding that occurs without trauma or known structural abnormality. Hypertension is a main cause of sICH, but liver cirrhosis may be another reason; however, this rarely occurs under anesthesia. We report on a case of sICH in a 75-yearold woman patient with liver cirrhosis during left hemihepatectomy. And the literature on the usefulness of perioperative bispectral index monitoring for early detection of brain damage is reviewed.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Intracerebral Hemorrhage in Patients With Chronic Liver Disease

Cited by 19 publications

References 13 publications

Discharge Disposition After Stroke in Patients With Liver Disease

Discharge Disposition After Stroke in Patients With Liver Disease

Association between Liver Disease and Intracranial Hemorrhage

Spontaneous intracerebral hemorrhage during left hemihepatectomy in a cirrhotic patient

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