Liver Fibrosis Indices and Hemorrhagic Transformation After Ischemic Stroke

Abstract

Background: Hemorrhagic transformation (HT) is recognized as a common compilation of acute ischemic stroke. The aim of this study was to investigate whether liver fibrosis indices are related to HT. Methods: We included ischemic stroke patients within 7 days of symptom onset. We calculated 3 liver fibrosis indices including the Aspartate Aminotransferase - Platelet Ratio Index (APRI), the Fibrosis - 4 (FIB - 4) score, and the Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) . Primary outcome was HT and secondary outcomes were symptomatic HT or parenchymal hemorrhage. We used multivariate logistic regression to assess the association between liver fibrosis indices and outcomes. Results: Among 2033 patients with ischemic stroke, the median APRI, FIB - 4 and NFS were significantly higher in HT cases compared with controls (APRI: 0.37 vs. 0.31; FIB-4: 2.44 vs. 1.86; 0.13 vs. -0.30, respectively; all P <0.001). After adjustment for potential confounders, the OR (95%CI) of HT for those in the highest tertile of APRI was 1.53 (1.05 - 2.24) compared with patients in the lowest tertile ( P for trend = 0.038). FIB - 4 (OR 1.28, 95% CI 0.82 - 2.01; P for trend = 0.07) and NFS (OR 1.31, 0.71 - 2.44; P for trend = 0.068) were not associated with HT. Indices were not associated with the secondary outcomes. Conclusions: In patients with ischemic stroke, high APRI was associated with increased risks of HT, suggesting that APRI might be a prognostic biomarker for HT after acute ischemic stroke.