End-Stage Liver Disease in Patients with Intracranial Hemorrhage Is Associated with Increased Mortality: A Cohort Study

Carlito Lagman, Daniel T. Nagasawa, John P. Sheppard, Cheng Hao Jacky Chen, Thien Nguyen, Giyarpuram N. Prashant, Tianyi Niu, Alexander M. Tucker, Won Kim, Nader Pouratian, Fady M. Kaldas, Ronald W. Busuttil, Isaac Yang

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine if end-stage liver disease (ESLD) in patients with intracranial hemorrhage (ICH) is associated with increased mortality. Methods: This single-center, retrospective cohort study included 53 patients (33 in ESLD cohort and 20 in non-ESLD cohort) who received neurosurgical care between 2006 and 2017. ESLD was defined clinically as severely impaired liver function and at least 1 major complication of liver failure. The primary outcome was mortality. Results: Overall, in-hospital, and 30-day mortality rates were higher in the ESLD cohort versus the non-ESLD cohort (79 vs. 30%, 79 vs. 20%, and 64 vs. 25%, all P ≤ 0.01). We identified a significant difference in overall survival between ESLD and non-ESLD cohorts on Kaplan-Meier analysis (P = 0.004 with log-rank and Wilcoxon tests). Odds of overall, in-hospital, and 30-day mortality in the ESLD cohort were 8.67 (95% confidence interval [CI], 2.44–30.84), 14.86 (95% CI, 3.75–58.90), and 5.25 (95% CI, 1.53–18.08). Other predictors of overall mortality included primary admission diagnosis of liver disease (odds ratio [OR] = 9.60; 95% CI, 3.75–58.90), higher Child-Pugh (OR = 1.64; 95% CI, 2.66–34.67) and Model for End-Stage Liver Disease (OR = 1.12; 95% CI, 1.04–1.20) scores, lower Glasgow Coma Scale score (OR = 0.73; 95% CI, 0.61–0.88), ICH that developed in the hospital (OR = 4.11; 95% CI, 1.21–13.98), and intraparenchymal hemorrhage (OR = 9.23; 95% CI, 1.72–49.56). Conclusions: ESLD in patients with ICH is associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)e320-e327
JournalWorld neurosurgery
Volume113
DOIs
StatePublished - May 2018
Externally publishedYes

Keywords

  • Intracranial hemorrhages
  • Liver diseases
  • Mortality
  • Neurosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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