title: Association between Liver Disease and Intracranial Hemorrhage.
abstract: BACKGROUND
  Liver disease is common and associated with clinical and laboratory evidence of coagulopathy. The association between liver disease and intracranial hemorrhage (ICH) remains unclear. Our aim was to assess whether liver disease increases the risk of ICH.
  
  
  METHODS
  We performed a retrospective cohort study based on administrative claims data from California, Florida, and New York acute care hospitals from 2005 through 2011. Of a random 5% sample, we included patients discharged from the emergency department or hospital after a diagnosis of liver disease and compared them to patients without liver disease. Patients with cirrhotic liver disease were additionally analyzed separately. Kaplan-Meier survival statistics were used to calculate cumulative rates of incident ICH, and Cox proportional hazard analysis was used to adjust for demographic characteristics, vascular disease, and Elixhauser comorbidities. Multiple models tested the robustness of our results.
  
  
  RESULTS
  Among 1,909,816 patients with a mean follow-up period of 4.1 (±1.8) years, the cumulative rate of ICH after a diagnosis of liver disease was 1.70% (95% confidence interval [CI], 1.55%-1.87%) compared to .40% (95% CI, .39%-.41%) in patients without liver disease (P <.001 by the log-rank test). Liver disease remained associated with an increased hazard of ICH after adjustment for demographic characteristics and vascular risk factors (hazard ratio [HR], 1.8; 95% CI, 1.6-2.0). This was attenuated in models additionally adjusted for general comorbidities (HR, 1.3; 95% CI, 1.2-1.5).
  
  
  CONCLUSIONS
  There is a modest, independent association between liver disease and the risk of ICH.
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York. Electronic address: nsp2001@nyp.org.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Parikh
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors.forename: Babak B
authors.initials: BB
authors.lastname: Navi
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York.
authors.forename: Sonal
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018672:Community Health Planning; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: Intracranial hemorrhage; cirrhosis; coagulopathy; epidemiology; intracerebral hemorrhage; liver disease