Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York New York.
Department of Neurology Columbia University Medical Center New York New York.
Ann Clin Transl Neurol. 2018 Nov 5;6(1):27-32. doi: 10.1002/acn3.675. eCollection 2019 Jan.
Cirrhosis has been associated with nontraumatic subarachnoid hemorrhage (SAH). We sought to evaluate the specific association between cirrhosis and aneurysmal SAH.
We performed a retrospective cohort study using a sample of Medicare claims data from 2008 to 2015. Cirrhosis was defined using a validated diagnosis code algorithm. Nontraumatic SAH was identified using a validated approach requiring an inpatient claim for its diagnosis code. Additionally, we required the presence of an procedure code reflecting treatment of a cerebral aneurysm during the same hospitalization to ensure ascertainment of aneurysmal SAH specifically. We used survival statistics to calculate incidence rates and Cox proportional hazards models to evaluate the association between cirrhosis and aneurysmal SAH after adjustment for demographics, stroke risk factors, and comorbidities.
We identified 10,658 (0.6%) patients with cirrhosis from among the 1,778,604 beneficiaries in our sample. The mean age of patients with cirrhosis was 73.5 (±7.8) years, and 48% were female. Over a mean of 4.7 (±2.1) years of follow-up, 4,272 patients were hospitalized with aneurysmal SAH. The annual incidence of aneurysmal SAH in patients with cirrhosis was 0.12% (95% confidence interval [CI], 0.08-0.17%) compared to 0.05% (95% CI, 0.05-0.05%) in patients without cirrhosis. In the adjusted model, cirrhosis was independently associated with aneurysmal SAH (hazard ratio, 2.2; 95% confidence interval, 1.5-3.4).
Cirrhosis was independently associated with an increased risk of aneurysmal SAH among older individuals. Confirmation of these findings may yield opportunities for risk stratification and prevention.
肝硬化与非创伤性蛛网膜下腔出血（SAH）有关。我们旨在评估肝硬化与动脉瘤性 SAH 之间的具体关联。
我们使用 2008 年至 2015 年医疗保险索赔数据进行回顾性队列研究。肝硬化使用经过验证的诊断代码算法定义。非创伤性 SAH 使用经过验证的方法确定，需要住院诊断代码的住院索赔。此外，我们需要存在反映同一住院期间脑动脉瘤治疗的程序代码，以确保明确确定动脉瘤性 SAH。我们使用生存统计计算发病率，并使用 Cox 比例风险模型评估肝硬化与动脉瘤性 SAH 之间的关联，调整人口统计学、中风危险因素和合并症后进行评估。
我们从样本中的 1778604 名受益人中确定了 10658 名（0.6%）患有肝硬化的患者。肝硬化患者的平均年龄为 73.5（±7.8）岁，48%为女性。在平均 4.7（±2.1）年的随访中，有 4272 名患者因动脉瘤性 SAH 住院。肝硬化患者的动脉瘤性 SAH 年发病率为 0.12%（95%置信区间[CI]，0.08-0.17%），而无肝硬化患者的发病率为 0.05%（95% CI，0.05-0.05%）。在调整模型中，肝硬化与动脉瘤性 SAH 独立相关（风险比，2.2；95%置信区间，1.5-3.4）。
肝硬化与老年人动脉瘤性 SAH 的风险增加独立相关。这些发现的证实可能为风险分层和预防提供机会。
