Ztriva Eleftheria, Protopapas Adonis, Mentizis Pavlos, Papadopoulos Anastasios, Gogou Christiana, Kiosi Maria, Kyziroglou Maria, Minopoulou Ioanna, Gkounta Anastasia, Papathanasiou Erofili, Cholongitas Evangelos, Savopoulos Christos, Tziomalos Konstantinos
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece.
First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece.
J Clin Med. 2022 Aug 31;11(17):5141. doi: 10.3390/jcm11175141.
Background: Nonalcoholic fatty liver disease, particularly in the presence of hepatic fibrosis, is associated with an increased risk of cardiovascular events, including ischemic stroke. However, it is unclear whether hepatic fibrosis is associated with the severity and outcome of acute ischemic stroke. Aim: To evaluate the relationship between hepatic fibrosis and the severity at admission and in-hospital outcome of acute ischemic stroke. Patients and methods: We prospectively studied all patients who were admitted to our department with acute ischemic stroke between September 2010 and February 2018 (n = 1107; 42.1% males, age 79.8 ± 7.2 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥ 21. The presence of hepatic fibrosis was evaluated with the Fibrosis-4 index (FIB-4). The outcome was assessed with dependency at discharge (modified Rankin Scale between 2 and 5) and with in-hospital mortality. Results: Patients with severe stroke had a higher FIB-4 index than patients with non-severe stroke (2.7 ± 1.7 and 2.3 ± 1.4, respectively; p < 0.05). Independent risk factors for severe IS were age (relative risk (RR) 1.064, 95% confidence interval (CI) 1.030−1.100, p < 0.001), female sex (RR 1.723, 95% CI 1.100−2.698, p = 0.012), atrial fibrillation (RR 1.869, 95% CI 1.234−2.831, p = 0.002), diastolic blood pressure (DBP) (RR 1.019, 95% CI 1.006−1.033, p = 0.001), and the FIB-4 index (RR 1.130, 95% CI 1.007−1.268, p = 0.022). At discharge, 64.2% of patients were dependent. The FIB-4 index did not differ between patients who were dependent and those who were independent at the time of discharge (2.3 ± 1.5 and 2.1 ± 1.2, respectively; p = 0.061). During hospitalization, 9.8% of patients died. Patients who died during hospitalization had a higher FIB-4 index than those who were discharged (2.9 ± 1.8 and 2.3 ± 1.4, respectively; p < 0.005). Independent risk factors for in-hospital mortality were DBP (RR 1.022, 95% CI 1.010−1.034, p < 0.001), serum glucose levels (RR 1.004, 95% CI 1.001−1.007, p = 0.007), serum triglyceride levels (RR 0.993, 95% CI 0.987−0.999, p = 0.023), NIHSS (RR 1.120, 95% CI 1.092−1.149, p < 0.001), and the FIB-4 index (RR 1.169, 95% CI 1.060−1.289, p = 0.002). Conclusions: Hepatic fibrosis, evaluated with the FIB-4 index, appears to be associated with more severe ischemic stroke and might also represent an independent risk factor for in-hospital mortality in patients admitted with acute ischemic stroke.
非酒精性脂肪性肝病，尤其是存在肝纤维化时，与包括缺血性卒中在内的心血管事件风险增加相关。然而，尚不清楚肝纤维化是否与急性缺血性卒中的严重程度及预后相关。目的：评估肝纤维化与急性缺血性卒中入院时的严重程度及住院期间预后的关系。患者与方法：我们前瞻性研究了2010年9月至2018年2月间入住我科的所有急性缺血性卒中患者（n = 1107；男性占42.1%，年龄79.8±7.2岁）。入院时采用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度。严重卒中定义为NIHSS≥21。采用Fibrosis-4指数（FIB-4）评估肝纤维化的存在情况。出院时的依赖程度（改良Rankin量表评分为2至5分）及住院期间死亡率用于评估预后。结果：严重卒中患者的FIB-4指数高于非严重卒中患者（分别为2.7±1.7和2.3±1.4；p<0.05）。严重缺血性卒中的独立危险因素为年龄（相对危险度（RR）1.064，95%置信区间（CI）1.030 - 1.100，p<0.001）、女性（RR 1.723，95%CI 1.100 - 2.698，p = 0.012）、心房颤动（RR 1.869，95%CI 1.234 - 2.831，p = 0.002）、舒张压（DBP）（RR 1.019，95%CI 1.006 - 1.033，p = 0.001）及FIB-4指数（RR 1.130，95%CI 1.007 - 1.268, p = 0.022）。出院时，64.2%的患者存在依赖。出院时依赖与非依赖患者的FIB-指数无差异（分别为2.3±1.5和2.1±1.2；p = 0.061）。住院期间，9.8%的患者死亡。住院期间死亡患者的FIB-4指数高于出院患者（分别为2.9±1.8和2.3±1.4；p<0.005）。住院期间死亡的独立危险因素为DBP（RR 1.022，95%CI 1.010 - 1.034，p<0.001）、血糖水平（RR 1.004，95%CI 1.001 - 1.007，p = 0.007）、血清甘油三酯水平（RR 0.993，95%CI 0.987 - 0.999，p = 0.023）、NIHSS（RR 1.120，95%CI 1.092 - 1.149，p<0.001）及FIB-4指数（RR 1.169，95%CI 1.060 - 1.289，p = 0.002）。结论：采用FIB-4指数评估的肝纤维化似乎与更严重的缺血性卒中相关，并且可能也是急性缺血性卒中入院患者住院期间死亡的独立危险因素。
