Although liver diseases have already been identified as a risk factor for increased recurrence and mortality in patients with chronic subdural hematoma (CSDH), the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between the LF scores and CSDH recurrence.

We retrospectively analyzed consecutive patients with CSDH who underwent burr-hole irrigation in the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. The clinical data were collected, and the LF scores were calculated including aspartate aminotransferase–platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between the LF scores and CSDH recurrence, and Cox regression model and Fine–Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. The C-statistic, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI) evaluated the additive value of the LF scores to predict the recurrence of CSDH.

A total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas the standard hepatic assays were mostly normal. The patients were assigned to groups of high and low LF scores based on the validated cut-offs; compared with the subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, the LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4, and Forns score were 4.32 (1.37–13.60), 2.56 (1.20–5.43), and 2.02 (1.07–3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the C-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50 and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results.

The data from this study first indicated that the high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.

尽管肝病已被确定为慢性硬膜下血肿 (CSDH) 患者复发和死亡率增加的危险因素，但亚临床肝病，特别是肝纤维化 (LF) 与 CSDH 之间的关联仍然未知。在本研究中，我们旨在调查 LF 评分与 CSDH 复发之间的关联。

我们回顾性分析了2015年1月至2018年12月在温州医科大学第一附属医院接受钻孔冲洗的连续CSDH患者。收集临床资料，计算LF评分，包括天冬氨酸氨基转移酶-血小板比值指数（APRI )、fibrosis-4 (FIB-4) 和 Forns 指数。应用多变量逻辑回归分析来确定 LF 评分与 CSDH 复发之间的关联，并使用 Cox 回归模型和 Fine-Gray 竞争风险模型根据事件发生时间结果计算 CSDH 复发的风险比 (HRs)。C 统计量、综合鉴别改进 (IDI) 和净重分类改进 (NRI) 评估了 LF 分数的相加值以预测 CSDH 的复发。

共纳入419例CSDH患者，术后1年内62例患者（14.80%）出现血肿复发。复发患者的 LF 评分显着更高，而标准肝脏检测大多正常。根据验证的截止值将患者分配到高低 LF 评分组；与得分低的受试者相比，得分高的受试者的复发率明显更高。调整潜在混杂因素后，LF 评分与 CSDH 复发独立相关，APRI、FIB-4 和 Forns 评分较高的患者的多变量调整 HR（95% CI）分别为 4.32（1.37-13.60）、2.56（ 1.20–5.43) 和 2.02 (1.07–3.79) 分别表示 CSDH 的复发。而且，在传统模型中添加 APRI 将 C 统计量从 0.731 提高到 0.763，NRI 和 IDI 分别为 7.50 和 1.35%。另外两个常用的 LF 评分指数（FIB-4 评分和 Forns 指数）产生了可比较的结果。

该研究的数据首先表明，高 LF 评分与 CSDH 的复发显着相关，可能需要对这些患者进行仔细的随访。