Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study.

Autor:	Intagliata NM; University of Virginia Health System, Charlottesville, Virginia. Electronic address: nmi4d@uvahealth.org., Rahimi RS; Baylor Scott and White Hospital, Dallas, Texas., Higuera-de-la-Tijera F; Hospital General de México 'Dr. Eduardo Liceaga,' Saint Luke School of Medicine, Mexico City, Mexico., Simonetto DA; Mayo Clinic, Rochester, Minnesota., Farias AQ; University of São Paulo School of Medicine, São Paulo, Brazil., Mazo DF; School of Medical Sciences of University of Campinas (UNICAMP), São Paulo, Brazil., Boike JR; Northwestern University Feinburg School of Medicine, Chicago, Illinois., Stine JG; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania., Serper M; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Pereira G; Bonsucesso Federal Hospital (Ministry of Health), Rio de Janeiro, Brazil, and Estácio de Sá School of Medicine-Instituto de Educação Médica, Rio de Janeiro, Brazil., Mattos AZ; Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil., Marciano S; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Davis JPE; Washington DC Veterans Affairs Medical Center, Washington, DC., Benitez C; Pontificia Universidad Católica de Chile, Santiago, Chile., Chadha R; Mayo Clinic Florida, Jacksonville, Florida., Méndez-Sánchez N; Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico., deLemos AS; Wake Forest University School of Medicine, Atrium Health, Charlotte, North Carolina., Mohanty A; Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts., Dirchwolf M; Hospital Privado de Rosario, Rosario, Argentina., Fortune BE; Montefiore Einstein Center for Transplantation, New York, New York., Northup PG; New York University Langone Health, New York, New York., Patrie JT; University of Virginia School of Medicine, Charlottesville, Virginia., Caldwell SH; University of Virginia Health System, Charlottesville, Virginia.
Jazyk:	angličtina
Zdroj:	Gastroenterology [Gastroenterology] 2023 Sep; Vol. 165 (3), pp. 717-732. Date of Electronic Publication: 2023 Jun 02.
DOI:	10.1053/j.gastro.2023.05.046
Abstrakt:	Background & Aims: Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. Methods: Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. Results: A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End-Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). Conclusions: Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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