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FIB-4 index and liver fibrosis are risk factors for long-term outcomes in atrial fibrillation-related stroke

Authors
Kim, Tae HyungKim, Seung YoungJung, Young KulYim, Hyung JoonJung, Jin-ManSeo, Woo-Keun
Issue Date
Jun-2022
Publisher
Elsevier BV
Keywords
Atrial fibrillation; Stroke; Liver fibrosis; Prognosis; Sex
Citation
Clinical Neurology and Neurosurgery, v.217
Indexed
SCIE
SCOPUS
Journal Title
Clinical Neurology and Neurosurgery
Volume
217
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/60917
DOI
10.1016/j.clineuro.2022.107235
ISSN
0303-8467
Abstract
Objective Liver fibrosis (LF) is associated with a poor prognosis in patients with ischemic stroke (IS). We aimed to assess whether LF affects long-term outcomes in patients with atrial fibrillation-related stroke or such effects vary according to sex. Methods We conducted a multicenter prospective cohort study of Korean patients with atrial fibrillation-related IS. We calculated the fibrosis-4 (FIB-4) index, and LF degree was categorized into two groups (non-advanced vs. advanced) based on the FIB-4 index. Recurrent IS, major adverse cardiac events (MACEs), and all-cause mortality were evaluated using Cox proportional hazard model. Results A total of 2897 patients were included; the median age was 75 (interquartile range 68–80) years, and 51.8% were men. The median follow-up period was 16.3 months. Of these patients, 23% had advanced LF indicated by FIB-4 index. Multivariable analysis in all populations demonstrated that the FIB-4 index and advanced LF were significantly associated with MACEs and all-cause mortality but not with recurrent IS. Furthermore, a sex disparity was observed in the outcomes of the patients. A high FIB-4 index in men was a significant predictor of recurrent IS [subdistribution hazard ratio (95% confidence interval): 1.08 (1.02–1.14)]. However, the significance of advanced LF disappeared in MACEs in women and in all-cause mortality in men. Conclusion The FIB-4 index and advanced LF indicated by FIB-4 index are independent prognostic factors for long-term outcomes in Asian patients with atrial fibrillation-related IS. However, these predictors may contribute differently to patient outcomes depending on the sex.
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2. Clinical Science > Department of Neurology > 1. Journal Articles
2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles

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Ansan Hospital (Department of Neurology, Ansan Hospital)
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