Abstract Details

Title Liver Fibrosis and Outcomes after Primary Intracerebral Hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S2 - Neurocritical Care (1:22 PM-1:33 PM)

Poster/Presentation
Number 003

Background Subclinical liver fibrosis is present in 5-9% of people and has been associated with cerebral microhemorrhages and cardiovascular disease. We hypothesized that liver fibrosis indices are associated with outcomes in ICH.

Objective To investigate the association between subclinical liver fibrosis and outcomes in primary intracerebral hemorrhage (ICH).

Design/Methods We performed a retrospective cohort study using the Virtual International Stroke Trials Archive – ICH database. Adult patients with primary ICH presenting within 6 hours of symptom onset were included. Three validated fibrosis indices were calculated: Aspartate aminotransferase Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) score, and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). The primary outcome was 90-day mortality; secondary outcomes were admission hematoma volume, hematoma expansion, and 90-day disability. Multivariable linear and logistic regression were used to assess associations between each 1.0 unit change in fibrosis indices with outcomes. In secondary analyses, exposure variables were treated as categorical variables based on previously validated cut-offs.

Results

Among 432 patients with ICH, mean APRI, FIB-4, and NFS values were 0.4 (SD, 0.4), 1.9 (SD 1.4), and 0.3 (SD, 1.3), respectively; the means reflect intermediate probability of fibrosis. Standard liver function tests and coagulation parameters were largely in the normal range. After adjusting for confounding factors, APRI was associated with 90-day mortality (OR 1.8; 95% CI 1.1-2.9) and hematoma expansion (OR 2.0; 95% CI 1.2-3.7). FIB-4 was also associated with mortality (OR 1.3; 95% CI 1.1-1.7) and hematoma expansion (OR 1.3; 95% CI 1.1-1.6). Similarly, NFS was associated with mortality (OR 1.4; 95% CI 1.1-1.9) and hematoma expansion (OR 1.2; 95% CI 1.1-1.5). Indices were not associated with admission hematoma volume or 90-day disability. Results of secondary analyses were consistent.

Conclusions In patients without evidence of overt liver disease, liver fibrosis indices were associated with 90-day mortality and hematoma expansion after ICH.

Authors/Disclosures
Neal S. Parikh, MD (Alnylam Pharmaceuticals) PRESENTER	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for cases of neurological illness. Dr. Parikh has stock in Alnylam Pharmaceuticals. The institution of Dr. Parikh has received research support from Leon Levy Foundation. The institution of Dr. Parikh has received research support from Florence Gould Foundation. The institution of Dr. Parikh has received research support from NY State Empire Clinical Research Investigator Program. The institution of Dr. Parikh has received research support from NIA. The institution of Dr. Parikh has received research support from Medtronic.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has nothing to disclose.
Alexander Merkler, MD	Dr. Merkler has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurohospitalist. Dr. Merkler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for n/a.
	No disclosure on file
Jesse Dawson	Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boeringher Ingelheim. Jesse Dawson, 12284 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Mitchell S. Elkind, MD, MS, FAAN	Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.
Daniel F. Hanley, MD, FAAN (Johns Hopkins Medicine, Acute Care Neurology)	Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.
Wendy C. Ziai, MD (Johns Hopkins Univ, Neuro Critical Care)	Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lumosa. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bard. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ziai has received research support from NIH. Dr. Ziai has received publishing royalties from a publication relating to health care. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant with DOJ.
Santosh B. Murthy, MD (Weill Cornell Medicine)	Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Stroke and Neurological disorders. The institution of Dr. Murthy has received research support from National Institutes of Health/NINDS.

��ɫ��

��ɫ��