Prognostic Significance of Nonalcoholic fatty liver in Patients with Acute Ischemic Stroke: A large-scale nationwide, multicenter, prospective registry study
First author:Keyang Chen
Corresponding author:Xiaokun Li,Yongjun Wang
2023-02-28
Journal:Computers in Biology and Medicine
Publication type: Original Contributions
IF(IF): 6.69
PMID: 36924734 Link To Pubmed Full text Download
There is a lack of data regarding the relationship between nonalcoholic fatty liver disease (NAFLD) at admission and acute ischemic stroke (AIS) prognosis. We investigated the association between NAFLD risk and long-term outcomes, and whether the predictive ability would be improved after adding the index to previous conventional models for prognosis .
Continuous variables were reported as median with interquartile range or mean with standard deviation and categorical variables were showed as frequencies (percentages). Statistical comparisons were performed with the χ2 test or Fisher exact test, the Student t test, or the Mann-Whitney U test, as appropriate. Univariable and multivariable analyses with logistic or Cox regression were used to determine significant predictors of poor outcomes at 1-year follow-up. Variables adjusted in the conventional model included: age, sex, initial NIHSS score, TOAST classification, previous medical history of stroke, hypertension, diabetes, smoking, drinking. In addition, the area under the curve, net reclassification index (NRI), and absolute integrated discrimination improvement (IDI) were calculated to establish the performance of two predicted scores (FLI and HSI) added to the conventional model, respectively. NRI is used to quantify amount of correct reclassification introduced by using a model with added variable, and IDI is used to quantify increase in separation of events and nonevents. NRI or IDI >0 reflected improvements in performance between new and old models [18]. Results with p-value < 0.05 were defined as statistically significant. The risk was expressed as the 95% CIs. All analyses were conducted using SAS version 9.4 statistical software (SAS Institute, Inc, Cary, NC).
NAFLD risk was linked to a lower risk of long-term death or major disability in people with AIS. The predictive value of objective NAFLD after AIS was demonstrated in our study.
On patient outcomes, the prognostic performance of two objective NAFLD parameters was evaluated. NAFLD was detected in 32.10-51.90% of AIS patients. After 1-year, 14.5% of the participants had died or suffered a severe outcome. After controlling for known risk factors, NAFLD was associated with a modest probability of adverse outcome (odds ratio,0.72[95% CI, 0.61-0.86] for FLI; odds ratio,0.68[95% CI, 0.55-0.85] for HSI). The inclusion of the two NAFLD indicators in the conventional prediction model was justified by the integrated discrimination index,continuing to increase the model’s overall redictive value for long-term adverse outcomes