Association Between Liver Fibrosis Markers and Hemorrhagic Transformation Following Endovascular Treatment for Acute Ischemic Stroke: A Chinese Stroke Center Study

Weiwei Gao,1– 3 Yanan Zhao,1 Jingjing She,1 Ziwei Wu,4 Lijuan Cai,1– 3 Xingyu Chen,1– 3 Renjing Zhu1– 3 1Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; National Advanced Center for Stroke; Xiamen Key Subspecialty of Neurointerventional Radiology, Xiamen, People’s Republic of China; 2Xiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, People’s Republic of China; 3Xiamen Quality Control Center for Stroke, Xiamen, People’s Republic of China; 4School of Medicine, Xiamen University, Xiamen, People’s Republic of ChinaCorrespondence: Renjing Zhu, Department of Neurology, Zhongshan Hospital of Xiamen University, 201-209 Hubin South Road, Xiamen, 361004, People’s Republic of China, Email [email protected]: To investigate the association between non-invasive liver fibrosis indices and the risk of hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) in patients with anterior circulation large vessel occlusion (LVO) stroke.Patients and Methods: In this single-center retrospective cohort study, we consecutively enrolled 340 patients with anterior circulation LVO stroke who underwent EVT at a comprehensive stroke center between January 2018 and December 2024. Eight non-invasive liver fibrosis indices were calculated based on fasting laboratory parameters obtained within 24 hours of admission. The primary outcomes were HT and sICH. Multivariable logistic regression and restricted cubic spline analyses were performed to assess the associations.Results: Of the 340 patients, 161 (47.4%) developed HT, and 69 (20.3%) experienced sICH. After adjusting for confounders, elevated fibrosis-4 index (FIB-4) (adjusted odds ratio [aOR]=1.25, 95% CI: 1.01– 1.56; aOR=1.48, 95% CI: 1.12– 1.94), the modified FIB-4 (aOR1.07, 95% CI: 1.01– 1.15; aOR=1.13, 95% CI: 1.04– 1.23), the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) (aOR=1.43, 95% CI: 1.03– 1.96; aOR=1.91, 95% CI: 1.16– 3.12), and the AST to ALT-platelet ratio index (AARPRI) (aOR=1.53, 95% CI: 1.07– 2.17; aOR=2.36, 95% CI: 1.45– 3.84) were independently associated with increased risks of both HT and sICH. Conversely, the FIB-5 index showed an inverse association (aOR=0.95, 95% CI: 0.91– 1.00; aOR=0.91, 95% CI: 0.85– 0.98). These indices demonstrated higher predictive values for sICH (AUC: 0.65– 0.70) than for HT (AUC: 0.61– 0.62). Notably, patients with parenchymal hematoma had significantly greater liver fibrosis indices than those with hemorrhagic infarction or no hemorrhage (all P< 0.05).Conclusion: Non-invasive liver fibrosis indices are independently associated with post-EVT hemorrhagic complications in anterior circulation stroke patients and may serve as readily accessible tools for risk stratification.Keywords: large vessel occlusion, liver fibrosis, hemorrhagic transformation, symptomatic intracerebral hemorrhage, endovascular therapy, stroke