Liver Fibrosis is Associated with Clinical Outcomes in Patients with Intracerebral Hemorrhage

Abstract

Background

Recent studies have reported the predictive value of liver fibrosis indices for hematoma enlargement in patients with intracerebral hemorrhage (ICH). However, little is known about the precise association between fibrosis and ICH prognosis. Thus, our study was designed to investigate the relevance of liver fibrosis, as evaluated by fibrosis-4 (FIB-4) score and poor outcomes after ICH.

Methods

We used data from a prospective, multi-center and registry-based database. In this study, patients were stratified by the higher cut-off value of a FIB-4 score ≥2.67. The two groups of patients were then compared with regard to baseline characteristics, ICH severity and follow-up outcomes. We performed univariable and multivariable logistic regression analysis to determine the prognostic value of a FIB-4 score ≥2.67 for major disability or death. Kaplan–Meier survival curves were used to analyze the association between different FIB-4 scores and survival rate.

Results

Our present study included 839 patients from 13 hospitals in Beijing. Participants with FIB-4 scores ≥2.67 had a larger baseline hematoma volume and a higher score on the modified Rankin Scale at follow-up (all p values <0.05). In the logistic regression analysis, liver fibrosis defined by a FIB-4 score ≥2.67 was independently associated with poor clinical outcomes at discharge and at 1 year (at discharge: adjusted odds ratio [95% CI] = 1.894 [1.120–3.202], p = 0.0172; at 1 year: adjusted odds ratio [95% CI] = 1.694 [1.021–2.809], p = 0.0412). However, this association was not observed at 3 months. During the follow-up period, patients with a FIB-4 score ≥2.67 also had a significantly lower survival rate according to Kaplan–Meier survival analysis.

Conclusion

Our study suggests that liver fibrosis defined by a FIB-4 score ≥2.67 is associated with poor clinical outcomes and lower survival rates in patients with mild to moderate ICH. These data provide reliable evidence for detecting fibrosis and managing related risk factors to improve prognosis after ICH.

Keywords:

• liver fibrosis
• FIB-4 score
• intracerebral hemorrhage
• clinical outcomes
• survival rate

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy/ethical restrictions.

Ethics Statement

The study was approved by the Institutional Review Board (IRB) of Beijing Tiantan Hospital, Captial Medical University. Written informed consents were obtained from all participants or their legal relatives for the publication of any potentially identifiable data or images included in this article.

Acknowledgments

The research was supported by the National Key Research and Development Program of the People’s Republic of China (Grant No.2018YFC1312200/ 2018YFC131224 & 2018YFC1705003), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-029) and Beijing Municipal Committee of Science and Technology (Z201100005620010). We thank all patients who participated in our study.

Disclosure

All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.