Background and Purpose- Cirrhosis-clinically overt, advanced liver disease-is associated with an increased risk of hemorrhagic stroke and poor stroke outcomes. We sought to investigate whether subclinical liver disease, specifically liver fibrosis, is associated with clinical and radiological outcomes in patients with primary intracerebral hemorrhage. Methods- We performed a retrospective cohort study using data from the Virtual International Stroke Trials Archive-Intracerebral Hemorrhage. We included adult patients with primary intracerebral hemorrhage presenting within 6 hours of symptom onset. We calculated 3 validated fibrosis indices-Aspartate Aminotransferase-Platelet Ratio Index, Fibrosis-4 score, and Nonalcoholic Fatty Liver Disease Fibrosis Score-and modeled them as continuous exposure variables. Primary outcomes were admission hematoma volume and hematoma expansion. Secondary outcomes were mortality, and the composite of major disability or death, at 90 days. We used linear and logistic regression models adjusted for previously established risk factors. Results- Among 432 patients with intracerebral hemorrhage, the mean Aspartate Aminotransferase-Platelet Ratio Index, Fibrosis-4, and Nonalcoholic Fatty Liver Disease Fibrosis Score values on admission reflected intermediate probabilities of fibrosis, whereas standard hepatic assays and coagulation parameters were largely normal. After adjusting for potential confounders, Aspartate Aminotransferase-Platelet Ratio Index was associated with hematoma volume (β, 0.20 [95% CI, 0.04-0.36]), hematoma expansion (odds ratio, 1.6 [95% CI, 1.1-2.3]), and mortality (odds ratio, 1.8 [95% CI, 1.1-2.7]). Fibrosis-4 was also associated with hematoma volume (β, 0.27 [95% CI, 0.07-0.47]), hematoma expansion (odds ratio, 1.9 [95% CI, 1.2-3.0]), and mortality (odds ratio, 2.0 [95% CI, 1.1-3.6]). Nonalcoholic Fatty Liver Disease Fibrosis Score was not associated with any outcome. Indices were not associated with the composite of major disability or death. Conclusions- In patients with largely normal liver chemistries, 2 liver fibrosis indices were associated with admission hematoma volume, hematoma expansion, and mortality after intracerebral hemorrhage.

中文翻译：

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原发性脑出血后肝纤维化指标和结果。

背景和目的——肝硬化——临床上明显的晚期肝病——与出血性卒中风险增加和卒中预后不良有关。我们试图调查亚临床肝病，特别是肝纤维化，是否与原发性脑出血患者的临床和放射学结果相关。方法——我们使用来自虚拟国际卒中试验档案-脑出血的数据进行了一项回顾性队列研究。我们纳入了症状发作 6 小时内出现原发性脑出血的成年患者。我们计算了 3 个经过验证的纤维化指标——天冬氨酸转氨酶-血小板比率指数、Fibrosis-4 评分和非酒精性脂肪肝纤维化评分——并将它们建模为连续暴露变量。主要结局是入院血肿体积和血肿扩大。次要结果是 90 天时的死亡率，以及主要残疾或死亡的复合结果。我们使用针对先前确定的风险因素进行调整的线性和逻辑回归模型。结果——在 432 名脑出血患者中，平均天冬氨酸氨基转移酶-血小板比率指数、Fibrosis-4 和非酒精性脂肪性肝病纤维化评分值反映了纤维化的中间概率，而标准肝脏检测和凝血参数基本正常。调整潜在混杂因素后，天冬氨酸转氨酶-血小板比指数与血肿体积（β，0.20 [95% CI，0.04-0.36]）、血肿扩大（比值比，1.6 [95% CI，1.1-2.3]）、和死亡率（比值比，1.8 [95% CI，1.1-2.7]）。Fibrosis-4 还与血肿体积（β，0.27 [95% CI，0.07-0.47]）、血肿扩大（比值比，1.9 [95% CI，1.2-3.0]）和死亡率（比值比，2.0 [ 95% 置信区间，1.1-3.6]）。非酒精性脂肪肝纤维化评分与任何结果均无关。指数与主要残疾或死亡的综合无关。结论：在肝化学基本正常的患者中，2 个肝纤维化指标与入院血肿体积、血肿扩大和脑出血后死亡率相关。指数与主要残疾或死亡的综合无关。结论：在肝化学基本正常的患者中，2 个肝纤维化指标与入院血肿体积、血肿扩大和脑出血后死亡率相关。指数与主要残疾或死亡的综合无关。结论：在肝化学基本正常的患者中，2 个肝纤维化指标与入院血肿体积、血肿扩大和脑出血后死亡率相关。