Increased risk of subdural hematoma in patients with liver cirrhosis
Background
Subdural hematoma (SDH) is associated with a high mortality rate. The risk of SDH in cirrhotic patients has not been well studied.


Aim
The aim of the study was to examine the risk of SDH in cirrhotic patients.


Design
A retrospective study from a universal insurance claims database of Taiwan.


Methods
A cohort of 9455 liver cirrhotic patients from 2000 to 2011 and an age-and sex-matched control cohort of 35992 subjects without cirrhosis were identified. The severity of liver cirrhosis was classified into uncomplicated and complicated according to presence of complications or not. The incidence and hazard ratio of SDH were measured by the end of 2011.


Results
The mean follow-up years were 4.34±3.45 years in the cirrhosis cohort and 6.36±3.28 years in the non-cirrhosis cohort. The incidence of SDH was 2.73-fold higher in the cirrhosis cohort than in the control cohort (29.3 vs. 10.9 per 10000 person-years), with an adjusted hazard ratio of 2.73 (95% CI = 2.19-3.42), 2.42 (95% CI = 1.89-3.08), and 5.07 (95% CI = 3.38-7.60) in the all liver cirrhosis, the uncomplicated liver cirrhosis, and the complicated liver cirrhosis patients compared to the control cohort. The adjusted hazard ratios were 2.65 (95% CI 2.06-3.41) for traumatic SDH and 3.09 (95% CI 1.91- 5.02) for non-traumatic SDH in liver cirrhosis patients, compared to the controls.


Conclusions
This study demonstrates that patients with cirrhosis are at higher risk of both traumatic and non-traumatic SDH than individuals without cirrhosis. The risk increases further in patients with complicated liver cirrhosis.