الفهرس 
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Abstract
Liver cirrhosis is complicated by extensive hemostatic dysfunctions. vWF is
found to be elevated and may expose these patients to thrombosis. Therefore, cirrhosis
may be associated with bleeding or thrombotic events. The prevalence of hemorrhagic
and ischemic stroke (IS) in liver cirrhosis ranged between 0.80 - 34.33% and 0.85 -
6.55% respectively.
This cross-section case-control study was conducted on 73 patients who
were selected from the inpatient and outpatients clinic of Tropical & Neuropsychiatry
Departments, Menoufia University Hospital in the period from February 2019 to
February 2020; they were 41 male (56.16%), 32 female (43.84%); their ages ranged
between 47 and 82 years with a mean value of 61.15±6.06 years and they were
classified into three groups: GI (cirrhosis group) included 22 cirrhotic patients, GII (IS
group) included 18 patients with new-onset acute IS and GIII (mixed group) included
33 cirrhotic patients with new-onset acute IS. Also, 20 healthy persons of matched age
& sex were included as a control (GIV).
The aim of the present study was to assess the risk of vWF in IS among
cirrhotic versus non-cirrhotic patients & its relation to IS severity & outcome.
Inclusion criteria: selected cirrhotic patients based on the presence of clinical,
laboratory, and imaging evidence of cirrhosis however selected IS patients based on
the presence of acute episodes of focal neurologic deficit of new-onset lasting > 24
hours. Informed consents were obtained from all patients & controls included in the
study approved by the local ethical committee of the Faculty of Medicine, Menoufia
University.
Exclusion Criteria: Patients were excluded from the study if they had a stroke
of any cause other than ischemic etiology, myocardial infarction, major surgery, severe
trauma or massive hemorrhage within the preceding three months, vasculitis,
malignancy, known bleeding or clotting diathesis other than those associated with
cirrhosis, current infection as well as if they were on NSAIDs, antiplatelet, coagulant,
anticoagulant medication.
All patients and controls were subjected to full clinical assessment, laboratory
tests (CBC, ALT, AST, serum bilirubin, albumin, INR, renal function test, serum
electrolytes, lipid profile, viral markers, prothrombin time, ESR, CRP and vWF
measurement by ELISA), imaging (abdominal ultrasonography, CT, and /or MRI
brain, trans-thoracic echocardiography, color Duplex doppler ultrasound on carotid &
vertebrobasilar arteries), Child‘s grading for all studied cirrhotic patients, assessment
of IS severity using NIHSS and neurologic outcome using MRS, IS subtyping by
TOAST classification as well as patients’ follow up was done to determine in-hospital
outcome however stroke patients were assess three months post-stroke. Data were
statistically analyzed using SPSS (statistical package for social science/IBM, Chicago,
USA) program version 13 for windows. P-value < 0.05 considered statistically
significant.
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Statistical analysis of the present data revealed:
No significant difference between studied groups regarding age and sex
distribution. Mean age value in the mixed group was < stroke group though nonsignificant,
male to female ratio in stroke and mixed stroke/cirrhosis groups were
1.25 : 1 and 1.36:1 respectively.
presence of highly significant hematemesis and melena among cirrhotic & mixed
groups compared to stroke group, significant systemic hypertension among
stroke group compared to other groups, significant hepatic encephalopathy
among cirrhotic groups compared to stroke group, while there was no significant
difference between studied patients‘ groups regarding smoking, DM and bleeding
from other sites.
presence of general manifestations of cirrhosis in cirrhotic groups, highly
significant increase in the mean values of systolic & diastolic blood pressure
among stroke group compared to cirrhosis & mixed groups and their highly
significantly decreased among cirrhosis group compared to mixed group.
Evident local abdominal clinical sings & imaging finding of cirrhosis in all
cirrhotic groups patients
Highly significant decrease in the mean Hb concentration and mean platelet count
in cirrhosis and mixed groups compared to stroke or control group while there
were no significant difference between other groups regarding mean Hb
concentration & mean platelet count.
Significant increase in the mean total WBCs in stroke group compared to cirrhosis
and mixed cirrhosis/stroke groups, significant decrease in the mean total WBC in
cirrhosis group compared to control group while there were no significant
difference between other groups regarding mean WBCs.
Significant increase in the mean ALT values in mixed group compared to stroke
group and control groups while there were no significant difference between other
groups regarding mean ALT values.
Highly significant increase in the mean AST values in mixed group compared to
Stroke & control groups and significant increase in their mean values in cirrhosis
group compared to stroke & control groups while there were no significant
difference between other groups regarding mean AST values.
Highly significant increase in the mean total serum bilirubin and INR values in
cirrhosis or mixed group compared to stroke & control and significant increase in
the mean serum total bilirubin values in cirrhosis group compared to mixed
group, while there were no significant difference between other groups regarding
mean serum total bilirubin & INR values.
Highly significant decrease in the mean serum albumin values in cirrhosis group
compared to stroke, mixed & control groups and in mixed group compared to
stroke & control groups, while there was no significant difference between stroke
&control groups regarding mean serum albumin values.
Significant increase in mean blood urea values in cirrhosis or mixed group
compared to stroke & control groups while there were no significant difference
between other groups regarding mean blood urea value, highly significant
increase in mean serum creatinine values in cirrhosis & mixed groups compared
to control group, significant increase in the mean values in mixed group compared
to stroke and in stroke compared to control group while there were no significant
difference between other groups regarding mean serum creatinine values.
Highly significant decrease in mean serum Na values in cirrhosis group compared
to stroke & control groups and in mixed group compared to stroke
group,significant decrease in their mean values in mixed group compared to
control group while there were no significant difference between other groups
regarding mean serum Na values, no significant difference between studied groups
regarding mean serum k values.
Highly significant increase in the mean serum triglyceride values among stroke
group compared to cirrhosis & control groups and in mixed group compared to
control group, significant increase in mixed group compared to cirrhosis group
while there were no significant difference between other groups regarding mean
serum triglyceride values.
Highly significant increase in mean serum cholesterol & LDL values among
stroke & mixed groups compared to cirrhosis or control group while there were no
significant difference between other groups regarding mean serum cholesterol &
LDL values
Highly significant decrease in mean serum HDL values among cirrhosis group
compared to other groups,significant decrease in stroke & mixed groups compared
to control group while there was no significant difference between stroke &mixed
groups
Highly significant increase in mean serum vWF values among cirrhosis group
compared to stroke & control groups and in stroke & mixed groups compared to
control group,significant increase in cirrhosis group compared to mixed group
while there were no significant difference between stroke &mixed groups
regarding mean serum vWF values(though it was higher in mixed group)
Significant increase in the number of patients with Child’s grade B and significant
decrease in the number of patients with Child’s grade C in mixed group compared
to cirrhotic, the mean Child’s score value in cirrhosis group was significantly
higher compared to mixed group.
Highly significant difference between studied groups regarding carotid arteries
stenosis: Number of patients with mild carotid arteries stenosis was highly
significant in stoke groups compared to cirrhosis or control group and was
significant in cirrhosis group compared to control group while there was no
significant difference between stroke & mixed group regarding duplex.
No significant difference between stroke & mixed groups regarding ischemic
stroke subtypes defined by TOAST classification system.