Background and aims: Several studies have reported that cirrhosis may increase the risk of stroke. However, its association is controversial. We conducted a systematic review and meta-analysis to investigate the relationship between cirrhosis and the risk of stroke.
Methods: Relevant studies published before December 2017 were identified by searching PubMed, EMBASE, and the ISI Web of Science. The relationships between cirrhosis and the risk of stroke were assessed using relative risk (RR) values and the corresponding 95% confidence intervals (CIs). We used the random-effects model proposed by DerSimonian and Laird to quantify the relationship.
Results: Nine studies investigating the effect of cirrhosis on the risk of stroke were included, totaling 3,855,226 participants (26,199 ischemic stroke, 61,281 hemorrhagic stroke, 100,442 total stroke). Among those, four studies reported data for total stroke, six studies reported on hemorrhagic stroke, and four studies reported on ischemic stroke. The present study indicated a 24% increase in the risk of total stroke among patients with cirrhosis compared with healthy controls (RR: 1.24; 95% CI: 1.01-1.48). Subgroup analyses showed that cirrhosis was associated with increased risk of hemorrhagic stroke (RR: 1.35; 95% CI: 1.06-1.64) but not ischemic stroke (RR: 0.90; 95% CI: 0.41-1.38). Sensitivity analysis and 'trim and fill' method yielded similar results. No evidence of publication bias was observed.
Conclusions: Cirrhosis was associated with a higher risk of developing stroke, specifically hemorrhage stroke.
Keywords: Cerebrovascular disease; Cirrhosis; Fibrosis; Meta-analysis; Stroke.
Copyright © 2018. Published by Elsevier B.V.