Supplementary Material for: Liver Fibrosis, Not Steatosis, Associates with Long-Term Outcomes in Ischaemic Stroke Patients

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.

背景：本研究旨在探讨缺血性卒中或短暂性脑缺血发作（transient ischaemic attack, TIA）患者的肝纤维化负荷与脂肪变性负荷，是否与长期全因死亡率、心血管死亡率存在相关性差异。
方法：纳入2014年1月至2014年12月期间接受瞬时弹性成像（transient elastography, TE）检查的急性缺血性卒中或TIA连续患者作为研究队列。采用Cox比例风险模型，分析通过TE评估的肝纤维化或脂肪变性对患者长期临床结局的影响。
结果：本研究共纳入395例患者，其中37例（9.0%）存在显著肝纤维化（肝脏硬度值＞8.0 kPa），164例（41.5%）合并脂肪肝（脂肪衰减参数＞250 dB/m）。随访中位时长为2.7年，期间共有28例（7.1%）患者发生全因死亡，20例（5.1%）患者发生心血管死亡。多因素回归分析显示，显著肝纤维化与全因死亡（风险比[hazard ratio, HR] 8.14，95%置信区间[confidence interval, CI] 3.03~21.90，p＜0.001）及心血管死亡（HR 4.29，95%CI 1.10~16.73，p=0.036）风险升高呈独立正相关，而脂肪肝与上述结局无显著关联（所有p＞0.05）。
结论：本研究证实，通过TE评估的肝纤维化负荷而非脂肪变性负荷，可作为缺血性卒中患者长期随访期间全因死亡与心血管死亡的独立预测因子。