Department of Neurology, Medical University of Graz, Graz, Austria.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Eur J Neurol. 2022 Aug;29(8):2283-2288. doi: 10.1111/ene.15377. Epub 2022 May 24.
Non-alcoholic fatty liver disease and particularly liver fibrosis are related to cardiovascular disease and may indicate an increased risk for atrial fibrillation (AF), but this association has not yet been systematically investigated in a cohort of ischemic stroke patients.
We analyzed data from a prospective single-center study enrolling all consecutive ischemic stroke patients admitted to our stroke unit over a 1-year period. All patients received a thorough etiological workup. For evaluation of liver fibrosis, we determined the Fibrosis-4 (FIB-4) index, a well-established noninvasive liver fibrosis test. Laboratory results were analyzed from a uniform blood sample taken at stroke unit admission.
Of 414 included patients (mean age 70.2 years, 57.7% male), FIB-4 indicated advanced liver fibrosis in 92 (22.2%). AF as the underlying stroke mechanism was present in 28.0% (large vessel disease: 25.6%, small vessel disease: 11.4%, cryptogenic: 29.2%). Patients with FIB-4 ≥ 2.67 had higher rates of AF (53.3% vs. 20.8%, p < 0.001), and this association remained significant after correction for established AF risk factors (odds ratio 2.53, 95% confidence interval 1.44-4.46, p = 0.001). FIB-4 was further associated with worse functional outcome 3 months (p < 0.001) and higher mortality 4 years post-stroke (p < 0.02), but these relationships were no longer present after correction for age and initial stroke severity. Moreover, FIB-4 was not associated with long-term recurrent vascular events.
Liver fibrosis assessed by the FIB-4 index is independently associated with AF in acute ischemic stroke patients. Further studies should evaluate whether adding the FIB-4 index to AF risk scores increases their precision.
非酒精性脂肪性肝病，尤其是肝纤维化，与心血管疾病相关，并可能预示着心房颤动（AF）的风险增加，但这种关联尚未在缺血性脑卒中患者的队列中进行系统研究。
我们分析了一项前瞻性单中心研究的数据，该研究纳入了在 1 年内入住我们卒中单元的所有连续缺血性脑卒中患者。所有患者均接受了全面的病因学检查。为了评估肝纤维化，我们测定了纤维化-4 指数（FIB-4），这是一种成熟的非侵入性肝纤维化检测。在卒中单元入院时采集的统一血样中分析实验室结果。
在 414 例纳入患者中（平均年龄 70.2 岁，57.7%为男性），92 例（22.2%）的 FIB-4 提示存在严重的肝纤维化。作为潜在卒中机制的 AF 存在于 28.0%的患者中（大血管疾病：25.6%，小血管疾病：11.4%，隐源性：29.2%）。FIB-4≥2.67 的患者 AF 发生率更高（53.3%比 20.8%，p<0.001），校正已确定的 AF 危险因素后，这种关联仍然显著（优势比 2.53，95%置信区间 1.44-4.46，p=0.001）。FIB-4 还与 3 个月时的功能结局恶化（p<0.001）和卒中后 4 年的死亡率较高（p<0.02）相关，但校正年龄和初始卒中严重程度后，这些相关性不再存在。此外，FIB-4 与长期复发性血管事件无关。
用 FIB-4 指数评估的肝纤维化与急性缺血性脑卒中患者的 AF 独立相关。进一步的研究应评估将 FIB-4 指数添加到 AF 风险评分中是否会提高其准确性。
