PDF(Pubmed)
Abstract：
Some evidence suggests a possible influence of liver disease on stroke prognosis. We investigated the association between fibrosis-4 (FIB-4) score, a marker of liver disease, and the 3-month outcome in patients with ischemic stroke undergoing intravenous thrombolysis. We also evaluated the rate of symptomatic intracranial hemorrhage after thrombolysis. In this prospective cohort study, we enrolled consecutive patients with ischemic stroke treated with thrombolysis who had a 3-month follow-up. The FIB-4 score was calculated and the validated cut-off values were used to indicate high/low risk of advanced liver fibrosis. The primary outcome was 3-month poor prognosis estimated as a modified Rankin scale score ≥3. Of the 264 included patients, 131 (49.62%) had a 3-month mRS ≥3, with a significantly higher FIB-4 score, compared to those with a mRS <3 score (adjp <0.001). When adjusted for possible confounders by multivariate logistic regression, FIB-4 score remained a significant predictor of poor outcome (OR 1.894, p = 0.011), along with history of atrial fibrillation (OR 3.488, p = 0.017), admission NIHSS score (OR 1.305, p < 0.001), and low values of hemoglobin (OR 0.730, p < 0.001). Mechanical thrombectomy had a favorable effect on patients\' outcome (OR 0.201, p = 0.005). The risk of poor 3-month outcome was significantly higher among the 32 patients (12.1%) with high risk of severe fibrosis (p = 0.007). FIB-4 score values were also related to symptomatic intracranial hemorrhage (p = 0.004), specifically among patients with high probability of advanced hepatic fibrosis (p = 0.037). FIB-4 score can be considered as a promising independent predictor of poor prognosis in patients with acute ischemic stroke undergoing intravenous thrombolysis.
摘要：
一些证据表明肝病对中风预后可能有影响。我们调查了纤维化-4(FIB-4)评分之间的关联，肝脏疾病的标志，以及接受静脉溶栓治疗的缺血性卒中患者的3个月结局。我们还评估了溶栓后症状性颅内出血的发生率。在这项前瞻性队列研究中，我们连续纳入接受溶栓治疗的缺血性卒中患者,随访3个月.计算FIB-4评分，并使用验证的临界值来指示晚期肝纤维化的高/低风险。主要结果是3个月预后不良，估计为改良的Rankin量表评分≥3。在264名患者中，131（49.62％）的3个月mRS≥3，FIB-4评分明显更高，与mRS<3分（adjp<0.001）相比。当通过多变量逻辑回归对可能的混杂因素进行调整时，FIB-4评分仍然是不良结局的重要预测因子（OR1.894，p=0.011），房颤病史（OR3.488，p=0.017），入院NIHSS评分（OR1.305，p<0.001），和低血红蛋白值（OR0.730，p<0.001）。机械取栓对患者预后有良好的影响(OR0.201,p=0.005)。在32例严重纤维化风险较高的患者（12.1%）中，3个月预后不良的风险显著较高（p=0.007）。FIB-4评分值也与症状性颅内出血相关（p=0.004），特别是在晚期肝纤维化的高概率患者中（p=0.037）。FIB-4评分可作为急性缺血性卒中静脉溶栓患者预后不良的独立预测因子。
