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Risk of Liver Fibrosis Is Associated with More Severe Strokes, Increased Complications with Thrombolysis, and Mortality

Authors :
Emma M. S. Toh
Priscilla Roshini Joseph Ravi
Chua Ming
Amanda Y. L. Lim
Ching-Hui Sia
Bernard P. L. Chan
Vijay K. Sharma
Cheng Han Ng
Eunice X. X. Tan
Leonard L. L. Yeo
Daniel Q. Huang
Mark D. Muthiah
Benjamin Y. Q. Tan
Source :
Journal of Clinical Medicine, Vol 12, Iss 1, p 356 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

The Fibrosis (FIB)-4 index is an established non-invasive test to detect liver fibrosis. Liver fibrosis is postulated to be one of the predictors of the risk of symptomatic Intracranial Haemorrhage (SICH) after intravenous tissue plasminogen activator (IV tPA) therapy, the mainstay of treatment following acute ischemic stroke (AIS). However, SICH is a feared complication of thrombolytic therapy. We aimed to evaluate the association of FIB-4 with outcomes of AIS after IV tPA. Consecutive AIS patients receiving IV tPA from 2006 to 2018 at a single stroke centre were studied in a retrospective cohort study. Multivariable adjusted logistic regression was performed to assess associations of FIB-4 with outcomes. The primary outcome was SICH, and secondary outcomes included functional independence (mRS of 0–2) and mortality measured at 90 days. Among 887 patients (median age: 67 (IQR: 57–77)), 342 had FIB-4 < 1.3 and 161 had FIB-4 > 2.67. A greater proportion of moderate to severe strokes (NIHSS ≥10) occurred in the FIB-4 > 2.67 group (n = 142, 88.8%) compared to the FIB-4 < 1.3 group (n = 208, 61.2%). Amongst the different stroke subtypes, median FIB-4 was highest in cardioembolic stroke (CES) compared to the 3 other non-CES stroke subtypes (1.90 (IQR: 1.41–2.69)). Following IV tPA, having FIB-4 > 2.67 was associated with an increased rate of SICH (adjusted OR: 4.09, 95% CI: 1.04–16.16, p = 0.045) and increased mortality (adjusted OR 3.05, 95% CI: 1.28–7.26, p = 0.012). Advanced liver fibrosis was associated with an increased rate of SICH and increased 90-day mortality after IV tPA. The FIB-4 score may be useful for prognostication after IV tPA.

Details

Language :
English
ISSN :
20770383
Volume :
12
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Clinical Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.b28e6fd4c2a44f92bda5e0c85b2eaa96
Document Type :
article
Full Text :
https://doi.org/10.3390/jcm12010356