Evaluation of Risk Factors for Bleeding After Ultrasound-Guided Liver Biopsy

Abstract

This study was performed to analyze the risk factors for hemorrhagic complications after ultrasound-guided liver biopsies. Patients and Methods: In this retrospective study, we reviewed 1193 ultrasound-guided percutaneous liver biopsies performed in our hospital from January 2018 to December 2020. Relevant patient characteristics, indications for biopsy, laboratory findings, biopsy technique, hemorrhagic complications, and pathologic outcomes were collected. Results: We analyzed 834 procedures performed on 807 patients with complete data. The bleeding group comprised 45 patients with post-procedure bleeding, and non-bleeding group comprising the remaining 789 patients. Univariate analysis showed that age (p < 0.001), number of needle passes (p = 0.009), platelet count (p = 0.002), prothrombin time (p < 0.001), and international normalized ratio (p < 0.001) were associated with post-procedure bleeding. Multivariable regression analysis showed that age under 18 years (p < 0.001), low platelet count (p = 0.001), and increased needle passes (p = 0.025) were independent risk factors for bleeding complications. Conclusion: Sex and focal liver lesions did not affect the risk of post-procedure bleeding. The international normalized ratio and prothrombin time were associated with an increased incidence of bleeding; however, they had no predictive value. Age, number of needle passes, and platelet count were identified as reliable predictors of bleeding.

Application of alkaline phosphatase‑to‑platelet ratio as a novel noninvasive index predicts liver fibrosis in patients with chronic hepatitis B

“…Liver biopsy is currently the gold standard used for the assessment of liver fibrosis, although it is far from being perfect (4,5). Since it is an invasive procedure, it confers certain inevitable limitations such as pain, risk of severe complications and sampling errors that restrict its wider application to fibrosis screening in patients with CHB (6,7). Therefore, a number of non-invasive tests for fibrosis have been developed for clinical application, several of which are becoming widely applied.…”

Endothelial angiopoietin-2 overexpression in explanted livers identifies subjects at higher risk of recurrence of hepatocellular carcinoma after liver transplantation

“…The relevant gain in the prediction of HCC aggressiveness with its prognostic information can offset the risk associated with the biopsy maneuver. It should be underlined that severe complications, mostly hemorrhagic, have become rare, less than 0.5% with null mortality ( 18 , 19 ). Also, the issue of sampling error is more likely to affect the histologic interpretation rather than the molecular one.…”

Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan

“…However, we considered disease names, such as anemia or coagulation disorders and adopted an objective outcome of transfusion instead of a decline in the hemoglobin level. Second, information about the number of needle passes on same day as the PLB was unavailable, which was associated with major complications in a previous study [ 3 ]. Third, because of our small number of cases with major complications out of 3584 PLB cases in total, we could not evaluate the risk factors for major complications using multivariable analysis.…”

“…The primary outcome was major complications, defined as the occurrence of major bleeding or organ perforations necessitating transfusions or surgical interventions (vascular embolization or ligation, repair for pneumothorax or hemothorax, and exploratory laparotomy or thoracotomy) within six days of liver biopsy, as previously reported [ 3 , 6 , 20 ]. In-hospital death was observed in a very small number of patients undergoing major complications following PLB; however, we did not describe who died during hospitalization for protection of personal information.…”

“…Although noninvasive tools, such as transient elastography have been developed, percutaneous liver biopsy (PLB) remains the gold standard method for determining the etiology of liver dysfunction or disorder in pediatric patients with native and transplanted liver. Complication rates following PLB in pediatric populations are reportedly higher than those in adult populations [1][2][3][4], and serious complications, such as bleeding, organ perforation, and death have been observed even in children [5][6][7][8]. Therefore, risk stratification for PLB complications is particularly important in pediatric patients.…”