AUTHOR=Zhang Peng , Wang Hua , Bao Han , Wang Ning , Chen Zhen , Tu Qi , Lin Xiao , Li Yun , Zheng Zezheng , Chen Yu , Ruan Linhui , Zhuge Qichuan 

TITLE=Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.873124

DOI=10.3389/fneur.2022.873124

ISSN=1664-2295

ABSTRACT=Objective: Although liver diseases have already been identified as a risk factor for increased recurrence and mortality in chronic subdural hematoma (CSDH) patients, the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between LF scores and CSDH recurrence.
Methods: We retrospectively analysed consecutive CSDH patients who underwent burr-hole Irrigation in First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. Clinical data were collected, and LF scores were calculated including aspartate aminotransferase-platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between LF scores and CSDH recurrence, and Cox regression model and Fine and Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. C-statistic, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) evaluated the additive value of LF scores to predict the recurrence of CSDH.
Results: A total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas standard hepatic assays were largely normal. Patients were assigned to groups of high and low LF scores based on validated cutoffs, compared with subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4 and Forns score were 4.32 (1.37-13.60), 2.56 (1.20-5.43) and 2.02 (1.07-3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the c-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50% and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results.
Conclusions: The current data first indicated that high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.