Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 18, 2016; 8(35): 1564-1568
Published online Dec 18, 2016. doi: 10.4254/wjh.v8.i35.1564
Is cirrhosis associated with lower odds of ischemic stroke: A nationwide analysis?
Abhinav Goyal, Kshitij Chatterjee, Nishi Shah, Shailender Singh
Abhinav Goyal, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA 19141, United States
Kshitij Chatterjee, Nishi Shah, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Shailender Singh, Division of Gastroenterology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Author contributions: All the authors contributed to study design, analysis and writing of the manuscript.
Institutional review board statement: As this study was conducted using a de-identified commercially available database Institutional Review Board (IRB) approval was not required.
Informed consent statement: As this was a retrospective study conducted using a de-identified commercially available database, informed consent was neither feasible nor required.
Conflict-of-interest statement: The authors do not have any conflict of interest to disclose. No financial support of any kind was used for this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Abhinav Goyal, MD, Department of Internal Medicine, Einstein Medical Center, 5501 Old York Road, Suite 363, Klein Building, Philadelphia, PA 19141, United States.
Telephone: +1-215-4566500 Fax: +1-215-4551933
Received: August 21, 2016
Peer-review started: August 23, 2016
First decision: September 28, 2016
Revised: October 1, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: December 18, 2016

To determine the association between cirrhosis and ischemic stroke in a large nationally representative sample.


A retrospective cross-sectional study of all hospitalized patients during 2012 and 2013 in the United States was performed using the National Inpatient Sample database. Hospitalizations with acute stroke, cirrhosis and other risk factors were identified using ICD-9-CM codes.


There were a total of 72082638 hospitalizations in the United States during the years 2012 and 2013. After excluding hospitalizations with missing demographic variables, that there were a total of 1175210 (1.6%) out of these were for acute ischemic stroke. Cirrhosis was present among 5605 (0.4%) cases of ischemic stroke. Mean age among the cirrhotic and non-cirrhotic groups with ischemic stroke were 66.4 and 70.5 years, respectively. Prevalence of risk factors among the two groups was also calculated. After adjusting for various known risk factors the odds of having an ischemic stroke (OR = 0.28, P < 0.001) were 72% lower in cirrhotics compared to non-cirrhotics.


Our study suggests that in a large, nationally representative sample of the United States population, cirrhosis is associated with a lower likelihood of stroke.

Keywords: Cirrhosis, Ischemic stroke, Cerebrovascular accident, National Inpatient Sample

Core tip: Our study demonstrates that in a large, nationally representative sample, cirrhosis is associated with a lower likelihood of having an ischemic stroke, after adjusting for known risk factors. Although the odds of having a stroke are lower in cirrhotics, the mortality is significantly higher in them compared to non-cirrhotics.