Background: To investigate whether there are differences in long-term all-cause and cardiovascular mortality according to the burden of liver fibrosis or steatosis in patients with ischaemic stroke or transient ischaemic attack (TIA). -Methods: Consecutive patients with acute ischaemic stroke or TIA who underwent transient elastography (TE) from January 2014 to December 2014 were considered eligible. The influence of liver fibrosis or steatosis, assessed via TE, on long-term outcomes was investigated using Cox proportional hazard models. Results: Among 395 patients included in this study, there were 37 (9%) patients with significant fibrosis (> 8.0 kPa) and 164 (41.5%) patients with fatty liver (> 250 dB/m). During the follow-up period (median 2.7 years), all-cause and cardiovascular mortality occurred in 28 (7.1%) and 20 (5.1%) patients. On multivariate analyses, significant liver fibrosis was independently associated with increased risk of all-cause (hazard ratio [HR] 8.14, 95% CI 3.03–21.90, p < 0.001) and cardiovascular (HR 4.29, 95% CI 1.10–16.73, p = 0.036) mortality, whereas fatty liver was not (all p > 0.05). Conclusions: This study found that the burden of liver fibrosis but not that of steatosis, assessed via TE, was an independent predictor of all-cause and cardiovascular mortality during long-term follow-up in patients with ischaemic stroke.

1.
Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity.
Ann Med
. 2011 Dec; 43(8): 617–49.
2.
Kotronen A, Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome.
Arterioscler Thromb Vasc Biol
. 2008 Jan; 28(1): 27–38.
3.
Bataller R, Brenner DA. Liver fibrosis.
J Clin Invest
. 2005 Feb; 115(2): 209–18.
4.
Ekstedt M, Hagström H, Nasr P, Fredrikson M, Stål P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up.
Hepatology
. 2015 May; 61(5): 1547–54.
5.
Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis.
J Hepatol
. 2016 Sep; 65(3): 589–600.
6.
Unalp-Arida A, Ruhl CE. Liver fibrosis scores predict liver disease mortality in the United States population.
Hepatology
. 2017 Jul; 66(1): 84–95.
7.
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al.; GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.
Lancet
. 2016 Oct; 388(10053): 1459–544.
8.
Parikh NS, Merkler AE, Schneider Y, Navi BB, Kamel H. Discharge disposition after stroke in patients with liver disease.
Stroke
. 2017 Feb; 48(2): 476–8.
9.
Ying I, Saposnik G, Vermeulen MJ, Leung A, Ray JG. Nonalcoholic fatty liver disease and acute ischemic stroke.
Epidemiology
. 2011 Jan; 22(1): 129–30.
10.
Moshayedi H, Ahrabi R, Mardani A, Sadigetegad S, Farhudi M. Association between non-alcoholic fatty liver disease and ischemic stroke.
Iran J Neurol
. 2014 Jul; 13(3): 144–8.
11.
Abdeldyem SM, Goda T, Khodeir SA, Abou Saif S, Abd-Elsalam S. Nonalcoholic fatty liver disease in patients with acute ischemic stroke is associated with more severe stroke and worse outcome.
J Clin Lipidol
. 2017 Jul - Aug; 11(4): 915–9.
12.
Kim SU, Song D, Heo JH, Yoo J, Kim BK, Park JY, et al. Liver fibrosis assessed with transient elastography is an independent risk factor for ischemic stroke.
Atherosclerosis
. 2017 May; 260: 156–62.
13.
Li H, Hu B, Wei L, Zhou L, Zhang L, Lin Y, et al. Non-alcoholic fatty liver disease is associated with stroke severity and progression of brainstem infarctions.
Eur J Neurol
. 2018 Mar; 25(3): 577–e34.
14.
Lee BI, Nam HS, Heo JH, Kim DI; Yonsei Stroke Team. Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions.
Cerebrovasc Dis
. 2001; 12(3): 145–51.
15.
Kim SU, Choi GH, Han WK, Kim BK, Park JY, Kim DY, et al. What are ‘true normal’ liver stiffness values using FibroScan?: a prospective study in healthy living liver and kidney donors in South Korea.
Liver Int
. 2010 Feb; 30(2): 268–74.
16.
Branchi F, Conti CB, Baccarin A, Lampertico P, Conte D, Fraquelli M. Non-invasive assessment of liver fibrosis in chronic hepatitis B.
World J Gastroenterol
. 2014 Oct; 20(40): 14568–80.
17.
Chon YE, Jung KS, Kim SU, Park JY, Park YN, Kim DY, et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver -diseases: a prospective study of a native -Korean population.
Liver Int
. 2014 Jan; 34(1): 102–9.
18.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk.
J Am Stat Assoc
. 1999; 94(446): 496–509.
19.
Ajmal MR, Yaccha M, Malik MA, Rabbani MU, Ahmad I, Isalm N, et al. Prevalence of nonalcoholic fatty liver disease (NAFLD) in patients of cardiovascular diseases and its association with hs-CRP and TNF-α.
Indian Heart J
. 2014 Nov-Dec; 66(6): 574–9.
20.
Zou Y, Li X, Wang C, Wang J, Wang F, Ma L, et al. Association between non-alcoholic fatty liver disease and peripheral artery disease in patients with type 2 diabetes.
Intern Med J
. 2017 Oct; 47(10): 1147–53.
21.
Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome.
Diabetes Care
. 2001 Apr; 24(4): 683–9.
22.
You SC, Kim KJ, Kim SU, Kim BK, Park JY, Kim DY, et al. Hepatic fibrosis assessed using transient elastography independently associated with coronary artery calcification.
J Gastroenterol Hepatol
. 2015 Oct; 30(10): 1536–42.
23.
Ballestri S, Lonardo A, Bonapace S, Byrne CD, Loria P, Targher G. Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease.
World J Gastroenterol
. 2014 Feb; 20(7): 1724–45.
24.
Targher G, Bertolini L, Padovani R, Rodella S, Zoppini G, Zenari L, et al. Relations between carotid artery wall thickness and liver histology in subjects with nonalcoholic fatty liver disease.
Diabetes Care
. 2006 Jun; 29(6): 1325–30.
25.
Dam-Larsen S, Becker U, Franzmann MB, Larsen K, Christoffersen P, Bendtsen F. Final results of a long-term, clinical follow-up in fatty liver patients.
Scand J Gastroenterol
. 2009; 44(10): 1236–43.
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