Stroke And Liver Damage: Is There A Link?

can a stroke cause liver damage

Stroke is associated with a high risk of non-neurological complications, which include respiratory failure, cardiovascular dysfunction, kidney and liver injury, and altered immune and endocrine function. Liver failure is an important risk factor for cardiovascular disease, but its association with cerebrovascular diseases such as ischaemic and haemorrhagic stroke is still poorly investigated. However, a study found that approximately 61% of patients with no history of previous hepatobiliary dysfunction had abnormal hepatic enzyme levels at general intensive-care unit admission, and this finding was associated with increased short-term mortality.

A study of Medicare beneficiaries found that patients with cirrhosis faced an increased risk of stroke, particularly haemorrhagic stroke. Another study found that people with fatty liver disease may be three times more likely to suffer a stroke than individuals without fatty liver.

Characteristics Values
Stroke type Ischaemic stroke is associated with a high risk of non-neurological complications, including liver injury.
Liver cirrhosis is associated with an increased risk of stroke, particularly haemorrhagic stroke.
Patients with liver cirrhosis might have an increased risk of stroke probably due to their concomitant high-risk factors, such as coagulopathy, hypoperfusion, cardiac diseases, diabetes, and dyslipidemia.

medshun

Liver damage can be caused by ischaemic stroke-induced distal organ damage

Ischaemic strokes occur when blood supply to the brain is cut off. This can be caused by a blood clot or atherosclerosis, a disease that causes the narrowing of arteries over time. Ischaemic strokes account for the majority of all strokes.

Ischaemic stroke survivors require treatment in the acute setting and the prevention of secondary complications that might hinder functional recovery. Acute ischaemic stroke triggers a cascade of events, including local and systemic activation of the immune system, which can result in a number of systemic consequences and, ultimately, organ failure.

Respiratory failure

The lung is particularly susceptible to severe brain damage, such as that which follows ischaemic and haemorrhagic stroke. A recent clinical study found that, 36 hours after hospital admission, 15.6% of stroke patients had acute lung injury, and 7.8% developed pneumonia or bronchitis during their hospital stay.

Cardiovascular dysfunction

Stroke patients are extremely vulnerable to the development of severe cardiac complications, possibly due to changes in autonomic and neurohormonal pathways involved in the control of heart function. Acute cardiac dysfunction occurs in up to 67% of patients with ischaemic stroke. Common manifestations include arrhythmias, electrocardiographic (ECG) changes, and acute myocardial infarction-like complications.

Kidney and liver injury

Acute kidney injury (AKI) affects approximately 35% of patients admitted to intensive care units. In a recent meta-analysis, the pooled incidence of AKI was 9.6% in ischaemic stroke and 19.2% in haemorrhagic stroke. Risk factors for AKI among studies varied significantly, and all authors concluded that AKI after stroke significantly increases the mortality rate.

Following acute ischaemic stroke, glucose metabolism, and proteins implicated in insulin and growth hormone signalling in the liver are altered. Stroke-induced liver injury and hepatocyte dysfunction are associated with metabolic derangements, a decrease in hepatic transcription factors, and impaired host immune function, protein synthesis, and clearance of activated clotting factors. Liver failure is an important risk factor for cardiovascular disease, but its association with cerebrovascular diseases such as ischaemic and haemorrhagic stroke is poorly investigated. In a recent study, approximately 61% of patients with no history of previous hepatobiliary dysfunction had abnormal hepatic enzyme levels at general intensive-care unit admission, and this finding was associated with increased short-term mortality.

medshun

Hepatic complications can occur after an acute ischaemic stroke

The brain controls various body functions through complex neurohumoral mechanisms. Therefore, any severe cerebral insult, such as that which follows an acute ischaemic stroke, can induce several changes in specific neurosensory or neuromotor pathways, enhance the systemic response to local injury, and cause secondary peripheral organ damage.

Hepatic complications following an acute ischaemic stroke include changes in glucose metabolism, bilirubin, and liver enzyme levels. These changes can be detrimental to the brain, particularly in patients without diabetes. For example, stress-induced hyperglycaemia in patients without diabetes mellitus has been linked to higher morbidity and mortality rates compared to stroke patients with diabetes.

In addition, bilirubin, a byproduct of hepatic haemoglobin metabolism, can serve as a predictor of stroke severity and may hold therapeutic potential for reducing oxidative stress-induced stroke injury. However, excessive bilirubin levels can be toxic and are associated with larger cerebral infarcts, more pronounced cerebral oedema, and worse functional prognosis.

medshun

Liver cirrhosis patients may have an increased risk of stroke

Stroke is the second leading cause of death and disability worldwide. Liver cirrhosis is an end-stage liver disease. The association between liver cirrhosis and stroke is unclear. This article will review the current evidence regarding the association between liver cirrhosis and stroke and discuss the potential mechanisms for explaining such an association, such as coagulopathy, hypoperfusion, cardiac diseases, diabetes, and dyslipidemia.

Incidence/prevalence of stroke in liver cirrhosis

The prevalence of stroke in liver cirrhosis ranges from 2.06% to 53.81%. The prevalence of hemorrhagic stroke in liver cirrhosis is higher than that of ischemic stroke, ranging from 0.80% to 34.33%. The prevalence of ischemic stroke in liver cirrhosis ranges from 0.85% to 6.55%. The annual incidence of ischemic stroke in cirrhotic patients with atrial fibrillation is 1.2%. The prevalence of stroke in cirrhotic patients with atrial fibrillation is 53.81% and 34.58% in two separate studies. The annual incidence of aneurysmal subarachnoid hemorrhage (SAH) in cirrhotic patients is 0.11%.

Potential mechanisms for the association between stroke and liver cirrhosis

There are several potential mechanisms that could explain the association between stroke and liver cirrhosis. Coagulation and anticoagulation factors maintain a dynamic balance to prevent thrombosis and hemorrhage in healthy individuals. In contrast, coagulopathy is frequently observed in cirrhotic patients due to an imbalance between coagulation and anticoagulation factors. First, clotting factors are often decreased in cirrhotic patients and decrease further as liver disease progresses. Second, the mean lifetime of platelets is shortened, and thrombopoietin production is decreased in cirrhotic patients. Thrombocytopenia in cirrhotic patients can also be caused by hypersplenism, antiplatelet autoantibodies, toxic effects of excessive alcohol intake, and treatment with interferon. Third, a hypercoagulable status has been recognized in advanced cirrhosis due to increased levels of factor VIII and decreased levels of protein C. Therefore, both hemorrhage and thrombosis can occur in cirrhotic patients.

Hypoperfusion is another common occurrence in liver cirrhosis. This can be caused by ascites, which is a common clinical sign in cirrhotic patients due to liver dysfunction and portal hypertension. Additionally, serum albumin levels are often decreased in liver cirrhosis, which can decrease intravascular osmotic pressure. Massive gastrointestinal bleeding due to gastroesophageal variceal rupture, a common complication of liver cirrhosis, can also lead to hypoperfusion of various organs. Finally, there is a hyperdynamic circulation status in cirrhotic patients, characterized by arterial hypotension, high cardiac output, and low peripheral vascular resistance.

Study results

In a study by Parikh et al. that investigated the association between cirrhosis and various stroke types, patients with cirrhosis had a higher risk of stroke, particularly hemorrhagic stroke. The study found that cirrhosis was associated with a 40% higher risk of stroke and a stronger association with intracerebral hemorrhage and subarachnoid hemorrhage than with ischemic stroke. Another study by Wu et al. found that patients with liver cirrhosis had a 55% higher risk of stroke compared to those without cirrhosis. Additionally, liver cirrhosis was associated with a higher risk of epilepsy, admission to the intensive care unit, and in-hospital mortality after stroke.

In conclusion, liver cirrhosis patients may have an increased risk of stroke, particularly hemorrhagic stroke. This increased risk may be due to coagulopathy, hypoperfusion, cardiac diseases, diabetes, and dyslipidemia associated with liver cirrhosis. Further research is needed to better understand the association between liver cirrhosis and stroke and to develop strategies for preventing stroke and improving post-stroke outcomes in this vulnerable population.

medshun

Liver disease may be a predictor of stroke

Liver disease is associated with both haemorrhagic and thrombotic processes, including an elevated risk of intracranial haemorrhage. A study by St. Michael's Hospital and the London Health Sciences Centre found that people with fatty liver disease may be three times more likely to suffer a stroke than individuals without fatty liver. The study is the first to find a link between nonalcoholic fatty liver disease and stroke.

In a large, heterogeneous cohort of patients with stroke, researchers found an independent association between liver disease and worse hospital discharge disposition and in-hospital death. This association seemed more pronounced in patients with alcohol-related cirrhotic liver disease. The impact of liver disease on hospital discharge disposition after stroke did not vary by stroke type. However, in a secondary analysis, liver disease was more strongly associated with in-hospital death after ischaemic stroke than after intracerebral haemorrhage.

The observed influence of liver disease on discharge disposition after stroke may be multifactorial. Poor outcomes after intracerebral haemorrhage in this population may, in part, be because of increased haematoma size or expansion in patients with liver disease. Alternatively, patients with liver disease may be otherwise prone to decompensation because of non-neurological conditions, such as alcohol withdrawal or frailty. Lastly, possible interactions between liver disease and stroke treatment may play a role directly or limit the provision of therapies.

The relationships between nonalcoholic fatty liver disease, liver biomarkers, and ischaemic stroke are complex, and sex and race differences have been observed that require further study and confirmation.

Nonalcoholic fatty liver disease is a common condition that often has no symptoms or complications. Risk factors include obesity, high cholesterol, diabetes and, especially, insulin resistance.

medshun

Liver disease patients may be more susceptible to stroke

A stroke is a serious life-threatening medical condition that occurs when blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients from blood. Brain cells begin to die in minutes. A stroke is a medical emergency and timely treatment is crucial to minimize brain damage and potential complications. The longer the brain is deprived of blood flow, the greater the damage.

Liver disease is a broad term describing any single number of diseases or disorders that cause the liver to function improperly or cease functioning altogether. The liver is an extremely important organ that performs many crucial functions, including fighting infections, removing toxins from the blood, and making proteins and hormones that regulate bodily functions.

The link between liver disease and stroke is still being studied, but there is evidence that liver disease patients may be more susceptible to stroke. For example, a study by researchers at St. Michael's Hospital and the London Health Sciences Centre found that people with nonalcoholic fatty liver disease may be three times more likely to suffer a stroke than individuals without fatty liver. Another study found that cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke.

There are several potential mechanisms that could explain the association between stroke and liver cirrhosis. One is coagulopathy, a condition in which the blood's ability to clot is impaired. This can lead to both bleeding and thrombotic events in cirrhotic patients due to decreased levels of both procoagulant and anticoagulant factors. Another factor is hypoperfusion, which is often observed in liver cirrhosis due to reduced intravascular osmotic pressure and ascites, a common clinical sign in cirrhotic patients. Additionally, cardiac diseases, diabetes, and dyslipidemia are also associated with an increased risk of stroke in liver cirrhosis patients.

While the exact mechanism behind the link between liver disease and stroke is still being studied, there is evidence that liver disease patients may be more susceptible to stroke. Further research is needed to better understand the relationship between these two conditions and to develop strategies for prevention and treatment.

Frequently asked questions

Yes, acute ischaemic stroke is associated with a high risk of non-neurological complications, which include liver injury.

A stroke is an acute episode of focal dysfunction of the brain, retina, or spinal cord.

Liver damage is the destruction of liver tissue that can cause liver dysfunction.

Traditional risk factors for stroke include hypertension, decreased physical activity, unhealthy diet, smoking, cardiac disease, and diabetes mellitus.

Written by
Reviewed by
Share this post
Print
Did this article help you?

Leave a comment