Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea.
Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea; Zebrafish Translational Medical Research Center, Korea University Ansan Hospital, Ansan, South Korea.
Clin Neurol Neurosurg. 2022 Jun;217:107235. doi: 10.1016/j.clineuro.2022.107235. Epub 2022 Apr 4.
Liver fibrosis (LF) is associated with a poor prognosis in patients with ischemic stroke (IS). We aimed to assess whether LF affects long-term outcomes in patients with atrial fibrillation-related stroke or such effects vary according to sex.
We conducted a multicenter prospective cohort study of Korean patients with atrial fibrillation-related IS. We calculated the fibrosis-4 (FIB-4) index, and LF degree was categorized into two groups (non-advanced vs. advanced) based on the FIB-4 index. Recurrent IS, major adverse cardiac events (MACEs), and all-cause mortality were evaluated using Cox proportional hazard model.
A total of 2897 patients were included; the median age was 75 (interquartile range 68-80) years, and 51.8% were men. The median follow-up period was 16.3 months. Of these patients, 23% had advanced LF indicated by FIB-4 index. Multivariable analysis in all populations demonstrated that the FIB-4 index and advanced LF were significantly associated with MACEs and all-cause mortality but not with recurrent IS. Furthermore, a sex disparity was observed in the outcomes of the patients. A high FIB-4 index in men was a significant predictor of recurrent IS [subdistribution hazard ratio (95% confidence interval): 1.08 (1.02-1.14)]. However, the significance of advanced LF disappeared in MACEs in women and in all-cause mortality in men.
The FIB-4 index and advanced LF indicated by FIB-4 index are independent prognostic factors for long-term outcomes in Asian patients with atrial fibrillation-related IS. However, these predictors may contribute differently to patient outcomes depending on the sex.
肝纤维化（LF）与缺血性脑卒中（IS）患者的预后不良相关。我们旨在评估 LF 是否影响房颤相关性脑卒中患者的长期预后，以及这种影响是否因性别而异。
我们进行了一项多中心前瞻性队列研究，纳入了韩国房颤相关性 IS 患者。我们计算了纤维化-4 （FIB-4）指数，并根据 FIB-4 指数将 LF 程度分为两组（非进展性 vs. 进展性）。使用 Cox 比例风险模型评估复发性 IS、主要不良心脏事件（MACEs）和全因死亡率。
共纳入 2897 例患者，中位年龄为 75 岁（四分位距 68-80 岁），51.8%为男性。中位随访时间为 16.3 个月。其中，23%的患者 FIB-4 指数提示存在进展性 LF。多变量分析显示，FIB-4 指数和进展性 LF 与 MACEs 和全因死亡率显著相关，但与复发性 IS 无关。此外，患者的结局存在性别差异。男性中较高的 FIB-4 指数是复发性 IS 的显著预测因素[亚分布危险比（95%置信区间）：1.08（1.02-1.14）]。然而，在女性中，进展性 LF 在 MACEs 中的意义消失，在男性中，FIB-4 指数在全因死亡率中的意义消失。
FIB-4 指数和 FIB-4 指数提示的进展性 LF 是亚洲房颤相关性 IS 患者长期预后的独立预测因素。然而，这些预测因素可能因性别而异，对患者结局的贡献也不同。
