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

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.