Non-alcoholic cirrhosis and the risk of stroke: a 5-year follow-up study

Background/Aims As habitual heavy alcohol consumption is one of the major causes of cirrhosis in the western world, the majority of studies on the relationship between cirrhosis and stroke have focused on patients with alcohol-related liver diseases. Using a nationwide population-based dataset, this study therefore aimed to examine the risk of stroke among non-alcoholic cirrhosis patients over a 5-year period following their diagnosis with non-alcoholic cirrhosis, as compared with the general population during the same period. Methods We used the 'Longitudinal Health Insurance Database', derived from the Taiwan National Health Insurance program. The study cohort comprised 2336 patients with cirrhosis and the comparison cohort consisted of 11 680 randomly selected subjects. Stratified Cox's proportional hazard regressions were performed to compare the 5-year stroke survival rate for the two cohorts. Results In the total sample of 14 016 patients, 1187 patients (8.5%) experienced stroke during the 5-year follow-up period: 176 from the study cohort (7.5% of the patients with cirrhosis) and 1011 from the comparison cohort (8.7% of patients without cirrhosis) (P=0.076). After adjusting for the patients' geographical location, hypertension, diabetes, coronary heart disease, heart failure, atrial fibrillation and hyperlipidaemia, the regression analysis shows that patients with cirrhosis were less likely to experience stroke compared with those without cirrhosis during the 5-year period (hazard ratio=0.59, 95% confidence interval=0.52-0.67, P < 0.001). Conclusion We conclude that patients with non-alcoholic cirrhosis were at a reduced risk for stroke compared with the general population.