Deans' stroke musings: The Paradoxical Protective Effect of Liver Steatosis on Severity and Functional Outcome of Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, April 17, 2019

The Paradoxical Protective Effect of Liver Steatosis on Severity and Functional Outcome of Ischemic Stroke

This makes no sense. Go back and figure this out based on objective damage reports(size and location). NIHSS has no objectivity at all.

The Paradoxical Protective Effect of Liver Steatosis on Severity and Functional Outcome of Ischemic Stroke

Minyoul Baik¹,

Seung Up Kim^2,3,

Hyo Suk Nam¹,

Ji Hoe Heo¹ and

Young Dae Kim¹^*

¹Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
²Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
³Yonsei Liver Center, Severance Hospital, Seoul, South Korea

Background: There is very limited information on the relationship between non-alcoholic fatty liver disease (NAFLD) and the severity or functional outcomes of ischemic stroke or transient ischemic stroke (TIA). We investigated the correlation between NAFLD and stroke outcomes.

Methods: NAFLD was assessed in 321 patients with first-ever acute ischemic stroke or TIA, who underwent transient elastography from January 2014 to December 2014. The association of liver steatosis with stroke severity, assessed using the National Institute of Health Stroke Scale (NIHSS), was investigated using robust regression analysis. We also compared the functional outcome at 90 days according to the presence or burden of liver steatosis.

Results: NAFLD was observed in 206 (64.2%) patients. Patients with NAFLD had less severe stroke (median NIHSS score 2 vs. 3, P = 0.012) and more favorable functional outcome at 90 days (85.3 vs. 70.5, P = 0.004). Patients with NAFLD were likely to have a 23.3% lower [95% confidence interval (CI), −39.2 to −3.2%, P = 0.026] NIHSS score and a 2.5-fold higher (95% CI, 1.08–5.67, P = 0.033) possibility of favorable functional outcome in multivariate analysis.

Conclusions: Our study shows that a higher burden of liver steatosis seems to be associated with less severe stroke and better functional outcome after ischemic stroke or TIA.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases from simple steatosis to steatohepatitis with varying degree of fibrosis, and liver cirrhosis (1, 2). NAFLD is becoming the most common chronic liver disease worldwide including Korea, affecting approximately 25% of the general population (3, 4). NAFLD is closely associated with obesity, insulin resistance, and type 2 diabetes mellitus, and is even recognized as a manifestation of metabolic syndrome in the liver (5). Furthermore, NAFLD is known to be clearly associated with cardiovascular morbidity and mortality (6, 7), and liver fibrosis is especially considered the key determinant (7–11).

Ischemic stroke is also suggested to be associated with NAFLD, especially liver fibrosis (7, 10, 12). In the previous study, we found that there was 41.5% of patients with NAFLD in ischemic stroke patients (10), similar with previous reports (23.0–42.7%) from other countries (12–14). However, there is a paucity of studies attempting to find the association between NAFLD and the stroke severity or functional outcome after ischemic stroke (12, 14, 15). Some previous studies, which defined NAFLD as the presence of elevated aminotransferase levels without apparent causes (12, 14, 15), failed to show a statistically significant association between NAFLD and stroke outcomes (12, 15).

Therefore, we sought to assess the association between NAFLD and the severity or functional outcome in patents with ischemic stroke. In this study, the presence of NAFLD was based on transient elastography (TE), which is known to be a well-qualified method for the diagnosis of NAFLD and could separately evaluate the degree of liver steatosis and stiffness (16, 17).