Department of Neurology, Center of Cerebrovascular Disease, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China.
BMC Neurol. 2021 Dec 9;21(1):478. doi: 10.1186/s12883-021-02494-0.
Whether liver fibrosis is associated with increased risk for substantial hematoma expansion (HE) after intracerebral hemorrhage (ICH) is still uncertain. We evaluated the association between various liver fibrosis indices and substantial HE in a Chinese population with primary ICH.
Primary ICH patients admitted to West China Hospital within 24 h of onset between January 2015 and June 2018 were consecutively enrolled. Six liver fibrosis indices were calculated, including aspartate aminotransferase (AST)-platelet ratio index (APRI), AST/alanine aminotransferase ratio-platelet ratio index (AARPRI), fibrosis-4 (FIB-4), modified fibrosis-4 (mFIB-4), fibrosis quotient (FibroQ) and Forns index. Substantial HE was defined as an increase of more than 33% or 6 mL from baseline ICH volume. The association of each fibrosis index with substantial HE was analyzed using binary logistic regression.
Of 436 patients enrolled, about 85% showed largely normal results on standard hepatic assays and coagulation parameters. Substantial HE occurred in 115 (26.4%) patients. After adjustment, AARPRI (OR 1.26, 95% CI 1.00-1.57) and FIB-4 (OR 1.15, 95% CI 1.02-1.30) were independently associated with substantial HE in ICH patients within 24 h of onset, respectively. In ICH patients within 6 h of onset, each of the following indices was independently associated with substantial HE: APRI (OR 2.64, 95% CI 1.30-5,36), AARPRI (OR 1.55, 95% CI 1.09-2.21), FIB-4 (OR 1.35, 95% CI 1.08-1.68), mFIB-4 (OR 1.09, 95% CI 1.01-1.18), FibroQ (OR 1.08, 95% CI 1.00-1.16) and Forns index (OR 1.37, 95% CI 1.10-1.69).
Liver fibrosis indices are independently associated with higher risk of substantial HE in Chinese patients with primary ICH, which suggesting that subclinical liver fibrosis could be routinely assessed in such patients to identify those at high risk of substantial HE.
肝纤维化与脑出血（ICH）后大量血肿扩大（HE）的风险增加是否相关仍不确定。我们评估了中国原发性 ICH 患者中各种肝纤维化指标与大量 HE 的关系。
2015 年 1 月至 2018 年 6 月期间，在华西医院发病 24 小时内连续入组原发性 ICH 患者。计算了 6 个肝纤维化指标，包括天冬氨酸氨基转移酶（AST）-血小板比值指数（APRI）、AST/丙氨酸氨基转移酶比值-血小板比值指数（AARPRI）、纤维化-4（FIB-4）、改良纤维化-4（mFIB-4）、纤维化商数（FibroQ）和福恩斯指数。大量 HE 定义为基线 ICH 体积增加 33%或 6ml 以上。采用二元逻辑回归分析每个纤维化指标与大量 HE 的关系。
436 例患者中，约 85%的患者标准肝酶和凝血参数基本正常。115 例（26.4%）患者发生大量 HE。调整后，AARPRI（OR 1.26，95%CI 1.00-1.57）和 FIB-4（OR 1.15，95%CI 1.02-1.30）与发病 24 小时内的 ICH 患者大量 HE 独立相关。在发病 6 小时内的 ICH 患者中，以下每个指标均与大量 HE 独立相关：APRI（OR 2.64，95%CI 1.30-5.36）、AARPRI（OR 1.55，95%CI 1.09-2.21）、FIB-4（OR 1.35，95%CI 1.08-1.68）、mFIB-4（OR 1.09，95%CI 1.01-1.18）、FibroQ（OR 1.08，95%CI 1.00-1.16）和福恩斯指数（OR 1.37，95%CI 1.10-1.69）。
肝纤维化指标与中国原发性 ICH 患者大量 HE 的风险增加独立相关，这表明亚临床肝纤维化可在这些患者中常规评估，以识别大量 HE 风险较高的患者。
