title: Association between nonalcoholic fatty liver disease and acute ischemic stroke severity and outcome.
abstract: OBJECTIVE
  To evaluate the association of nonalcoholic fatty liver disease (NAFLD) with acute ischemic stroke severity and in-hospital outcome.
  
  
  METHODS
  We prospectively studied all patients who were admitted in our Department with acute ischemic stroke between September 2010 and August 2012 (n = 415; 39.5% males, mean age 78.8 ± 6.6 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS) score at admission. NALFD was defined as serum alanine aminotransferase and/or aspartate aminotransferase levels above the upper limit of normal in the absence of other causes of elevated aminotransferases levels [chronic hepatitis B or C, drug toxicity, increased alcohol consumption (> 21 and > 14 drinks per week in men and women, respectively), cholestatic diseases or rhabdomyolysis]. The outcome was assessed with the modified Rankin scale (mRS) score at discharge and in-hospital mortality. Adverse outcome was defined as mRS score at discharge ≥ 2. Dependency at discharge was defined as mRS score between 2 to 5.
  
  
  RESULTS
  NAFLD was present in 7.7% of the study population. Patients with NAFLD had lower serum high-density lipoprotein cholesterol and higher triglyceride levels than patients without NAFLD (P < 0.05 for both comparisons). Demographic data, the prevalence of other cardiovascular risk factors and the prevalence of established CVD did not differ between the two groups. At admission, the NIHSS score did not differ between patients with and without NAFLD (6.3 ± 6.4 and 8.8 ± 9.6, respectively; P = NS). At discharge, the mRS score did not differ between the two groups (1.9 ± 2.2 and 2.6 ± 2.2 in patients with and without NAFLD, respectively; P = NS). Rates of dependency at discharge were also similar in patients with and without NAFLD (36.8% and 55.0%, respectively; P = NS) as were the rates of adverse outcome (42.9% and 58.6%, respectively; P = NS). In-hospital mortality rates also did not differ between the 2 groups (8.0% and 7.0% in patients with and without NAFLD, respectively; P = NS).
  
  
  CONCLUSIONS
  The presence of NAFLD in patients admitted for acute ischemic stroke does not appear to be associated with more severe stroke or with worse in-hospital outcome.
authors.affiliation: Konstantinos Tziomalos, Vasilios Giampatzis, Stella D Bouziana, Marianna Spanou, Maria Papadopoulou, Athinodoros Pavlidis, Stavroula Kostaki, Andreas Bozikas, Christos Savopoulos, Apostolos I Hatzitolios, First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tziomalos
authors.forename: Vasilios
authors.initials: V
authors.lastname: Giampatzis
authors.forename: Stella D
authors.initials: SD
authors.lastname: Bouziana
authors.forename: Marianna
authors.initials: M
authors.lastname: Spanou
authors.forename: Maria
authors.initials: M
authors.lastname: Papadopoulou
authors.forename: Athinodoros
authors.initials: A
authors.lastname: Pavlidis
authors.forename: Stavroula
authors.initials: S
authors.lastname: Kostaki
authors.forename: Andreas
authors.initials: A
authors.lastname: Bozikas
authors.forename: Christos
authors.initials: C
authors.lastname: Savopoulos
authors.forename: Apostolos I
authors.initials: AI
authors.lastname: Hatzitolios
keywords: Aminotransferases; Cardiovascular disease; Cardiovascular risk; Nonalcoholic fatty liver disease; Obesity; Outcome; Stroke; Type 2 diabetes mellitus; γ-glutamyl transpeptidase