Background
Liver disease is common and associated with clinical and laboratory evidence of coagulopathy.
The association between liver disease and intracranial hemorrhage (ICH) remains unclear.
Our aim was to assess whether liver disease increases the risk of ICH.
Methods
We performed a retrospective cohort study based on administrative claims data from
California, Florida, and New York acute care hospitals from 2005 through 2011. Of
a random 5% sample, we included patients discharged from the emergency department
or hospital after a diagnosis of liver disease and compared them to patients without
liver disease. Patients with cirrhotic liver disease were additionally analyzed separately.
Kaplan–Meier survival statistics were used to calculate cumulative rates of incident
ICH, and Cox proportional hazard analysis was used to adjust for demographic characteristics,
vascular disease, and Elixhauser comorbidities. Multiple models tested the robustness
of our results.
Results
Among 1,909,816 patients with a mean follow-up period of 4.1 (±1.8) years, the cumulative
rate of ICH after a diagnosis of liver disease was 1.70% (95% confidence interval
[CI], 1.55%-1.87%) compared to .40% (95% CI, .39%-.41%) in patients without liver
disease (P < .001 by the log-rank test). Liver disease remained associated with an increased hazard
of ICH after adjustment for demographic characteristics and vascular risk factors
(hazard ratio [HR], 1.8; 95% CI, 1.6-2.0). This was attenuated in models additionally
adjusted for general comorbidities (HR, 1.3; 95% CI, 1.2-1.5).
Conclusions
There is a modest, independent association between liver disease and the risk of ICH.
Key Words
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Article info
Publication history
Published online: December 08, 2015
Accepted:
November 4,
2015
Received in revised form:
November 4,
2015
Received:
September 10,
2015
Footnotes
Grant support: This study was supported by grants K23NS082367 (Kamel) and K23NS091395 (Navi) from the National Institute of Neurological Disorders and Stroke, as well as the Michael Goldberg Stroke Research Fund (Kamel) and the Florence Gould Endowment for Discovery in Stroke (Navi).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.005
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
