Hepatic Fibrosis Is a Risk Factor for Greater Severity and Worse Outcome of Acute Ischemic Stroke

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.