Cirrhosis Is an Independent Risk Factor for Mortality in Ischemic Stroke—A Nationwide Analysis

TL;DR

Liver cirrhosis increases the risk of death in patients with ischemic stroke, according to a nationwide study.

Contribution

This study identifies cirrhosis as an independent risk factor for mortality in ischemic stroke patients.

Findings

Patients with cirrhosis had a 7% in-hospital mortality rate compared to 4.2% without cirrhosis.

Cirrhosis was associated with a 69% higher mortality risk after adjusting for confounders.

Cirrhosis patients were younger and predominantly male compared to those without cirrhosis.

Abstract

Background and Aims: Ischemic stroke remains a leading cause of preventable cardiovascular mortality worldwide, with emerging evidence suggesting an association between liver cirrhosis and both stroke occurrence and severity. However, the specific impact of cirrhosis on stroke-related mortality remains incompletely understood. Elucidating this relationship is crucial for improving risk stratification and early recognition of high-risk individuals.

Methods: We conducted a retrospective cohort study comparing ischemic stroke patients with cirrhosis to those without, using the National Inpatient Sample database for 2021. Univariate and multivariate logistic regression analyses were performed to compare various outcomes.

Results: A total of 536,199 discharges for ischemic stroke were included, among which 4464 had a documented history of liver cirrhosis. Discharges with cirrhosis were predominantly male (58.2%) with a mean age of 67 years, which was 2.17 years younger than those without cirrhosis. In-hospital mortality was 7% (95% CI: 5.5%–8.99%) among discharges with cirrhosis versus 4.2% (95% CI: 4.0%–4.33%) in those without.. After adjusting for cofounders in multivariate logistic regression, it was revealed that cirrhosis is associated with 69% higher mortality risk in stroke discharges (OR = 1.69, 95% CI: 1.27–2.25, p < 0.001).

Conclusions: Our study identifies liver cirrhosis as an independent risk factor for mortality among patients hospitalized with ischemic stroke. These findings underscore the necessity of incorporating proactive management strategies for liver cirrhosis into stroke care and prevention protocols, potentially improving outcomes in this high-risk population.

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