| Autor: |
Toh EMS; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore., Joseph Ravi PR; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore., Ming C; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore., Lim AYL; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Sia CH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Division of Cardiology, Department of Medicine, National University Heart Centre Singapore, Singapore 119074, Singapore., Chan BPL; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Sharma VK; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Ng CH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore., Tan EXX; Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Yeo LLL; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Huang DQ; Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Muthiah MD; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore 119074, Singapore., Tan BYQ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore. |
| Abstrakt: |
The Fibrosis (FIB)-4 index is an established non-invasive test to detect liver fibrosis. Liver fibrosis is postulated to be one of the predictors of the risk of symptomatic Intracranial Haemorrhage (SICH) after intravenous tissue plasminogen activator (IV tPA) therapy, the mainstay of treatment following acute ischemic stroke (AIS). However, SICH is a feared complication of thrombolytic therapy. We aimed to evaluate the association of FIB-4 with outcomes of AIS after IV tPA. Consecutive AIS patients receiving IV tPA from 2006 to 2018 at a single stroke centre were studied in a retrospective cohort study. Multivariable adjusted logistic regression was performed to assess associations of FIB-4 with outcomes. The primary outcome was SICH, and secondary outcomes included functional independence (mRS of 0−2) and mortality measured at 90 days. Among 887 patients (median age: 67 (IQR: 57−77)), 342 had FIB-4 < 1.3 and 161 had FIB-4 > 2.67. A greater proportion of moderate to severe strokes (NIHSS ≥10) occurred in the FIB-4 > 2.67 group (n = 142, 88.8%) compared to the FIB-4 < 1.3 group (n = 208, 61.2%). Amongst the different stroke subtypes, median FIB-4 was highest in cardioembolic stroke (CES) compared to the 3 other non-CES stroke subtypes (1.90 (IQR: 1.41−2.69)). Following IV tPA, having FIB-4 > 2.67 was associated with an increased rate of SICH (adjusted OR: 4.09, 95% CI: 1.04−16.16, p = 0.045) and increased mortality (adjusted OR 3.05, 95% CI: 1.28−7.26, p = 0.012). Advanced liver fibrosis was associated with an increased rate of SICH and increased 90-day mortality after IV tPA. The FIB-4 score may be useful for prognostication after IV tPA. |
