• Carlito Lagman, Daniel T Nagasawa, John P Sheppard, Cheng Hao Jacky Chen, Thien Nguyen, Giyarpuram N Prashant, Tianyi Niu, Alexander M Tucker, Won Kim, Nader Pouratian, Fady M Kaldas, Ronald W Busuttil, and Isaac Yang.
• Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
• World Neurosurg. 2018 May 1; 113: e320-e327.

ObjectiveTo determine if end-stage liver disease (ESLD) in patients with intracranial hemorrhage (ICH) is associated with increased mortality.MethodsThis 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.ResultsOverall, 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).ConclusionsESLD in patients with ICH is associated with increased mortality.Copyright © 2018 Elsevier Inc. All rights reserved.

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