Cirrhosis patients' stroke risks and adverse outcomes: Two nationwide studies

Background & aims The association between liver cirrhosis (LC) and stroke is not completely understood. Our purpose was to evaluate stroke risk and post-stroke outcomes in patients with LC. Methods We identified 6944 adults aged 20 years and older, newly diagnosed with LC, using the Taiwan's National Health Insurance Research Database from 2000 to 2005. The comparison cohort consisted of 27,776 adults without LC, randomly selected by frequency matching in age and sex. Events of new-onset stroke were identified from medical claims during the 2000–2013 follow-up period. Adjusted hazard ratios (HR) and 95% confidence intervals (CIs) of stroke associated with LC were calculated in the multiple Cox proportional hazard model. Another nested stroke cohort study of 21,267 hospitalized stroke patients analyzed adjusted odds ratios (ORs) and 95% CIs of adverse events after stroke, among patients with and without LC, between 2000 and 2009. Results The incidences of stroke for people with and without LC were 6.1 and 4.3 per 1000 person-years, respectively. Compared with the non-cirrhotic cohort, the adjusted HR of stroke was 1.55 (95% CI 1.28–1.87) for LC patients. Previous LC was associated with risks of epilepsy (OR 1.30, 95% CI 1.09–1.56), admission to intensive care unit (OR 1.23, 95% CI (1.14–1.32) and in-hospital mortality (OR 1.83, 95% CI 1.63–2.05) after stroke. Conclusions LC was associated with higher risk of stroke, and patients with LC had more complications and mortality after stroke. This susceptible population needs strategies to prevent stroke and post-stroke adverse events.