Liver Cirrhosis and Risk of Intracerebral Hemorrhage

Abstract

Background and Purpose-The purpose of this study was to investigate the risk of future intracerebral hemorrhage development in patients with liver cirrhosis. Methods-Data were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 948 patients with liver cirrhosis diagnosed in 1999 and 9480 age-and sex-matched patients of the same year. All patients were tracked from their index visits for 9 years. Results-Intracerebral hemorrhage developed in 1.3% of patients with liver cirrhosis and 1.0% of patients in the comparison cohort during the follow-up period. Log-rank test analysis showed no significant difference between the 2 cohorts (Pϭ0.39). A stratified Cox proportional regression model showed an adjusted hazard ratio of 1.62 (95% CI, 0.85 to 3.10) for patients with liver cirrhosis to develop intracerebral hemorrhage compared with patients without liver cirrhosis. Conclusions-Patients with liver cirrhosis had a similar intracerebral hemorrhage incidence rate but a trend of increased risk for intracerebral hemorrhage compared with the comparison cohort during the 9-year follow-up period. (Stroke. 2011;42:2615-2617.)Key Words: epidemiology Ⅲ intracerebral hemorrhage Ⅲ liver cirrhosis H ypertension, high alcohol intake, and old age are wellknown independent risk factors for intracerebral hemorrhage (ICH). 1,2 On the other hand, liver cirrhosis is frequently associated with hematologic complications, especially thrombocytopenia and coagulation disorders. 3 The risk for development of ICH in patients with liver cirrhosis remains elusive. Only a few studies have proposed that liver cirrhosis is a risk factor for ICH. 4 -6 However, these studies were either case series or case-control methodologies. The purpose of this study was to investigate the risk of ICH in patients with liver cirrhosis using a nationwide administrative database. Methods DatabaseThe National Health Insurance Research Database is a large computerized database released by the Bureau of National Health Insurance. The National Health Insurance Research Database is provided to the public in Taiwan for research purposes. This study used the Longitudinal Health Insurance Database 2005, which contains all the original claims data of 1 million beneficiaries randomly selected from 25.68 million individuals in the registry. Because confidentiality assurances were addressed by the Bureau of National Health Insurance, 7 Institutional Review Board approval was waived. SubjectsThe study cohort comprised patients seeking outpatient care in 1999 and who received a diagnosis of liver cirrhosis, International Classification of Diseases, 9th Revision, Clinical Modification, code 571.2 or 571.5. We assigned their first visit for the diagnosis of liver cirrhosis as the index visit. To enhance diagnostic validity, we selected only patients who had Ն2 consistent diagnoses of liver cirrhosis during January 1, 1999, to December 31, 1999, for the study group (nϭ1043). We excluded patients Ͻ20 years and those Ͼ80 years (nϭ16) and...

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