Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.
Equipe d'Accueil 4245, University of Tours, Tours, France.
Clin J Am Soc Nephrol. 2020 Nov 6;15(11):1587-1594. doi: 10.2215/CJN.14721219. Epub 2020 Oct 15.
The risk of major bleeding after percutaneous native kidney biopsy is usually considered low but remains poorly predictable. The aim of the study was to assess the risk of major bleeding and to build a preprocedure bleeding risk score.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our study was a retrospective cohort study in all 52,138 patients who had a percutaneous native kidney biopsy in France in the 2010-2018 period. Measurements included major bleeding (, blood transfusions, hemorrhage/hematoma, angiographic intervention, or nephrectomy) at day 8 after biopsy and risk of death at day 30. Exposures and outcomes were defined by diagnosis codes.
Major bleeding occurred in 2765 of 52,138 (5%) patients (blood transfusions: 5%; angiographic intervention: 0.4%; and nephrectomy: 0.1%). Nineteen diagnoses were associated with major bleeding. A bleeding risk score was calculated (Charlson index [2-4: +1; 5 and 6: +2; >6: +3]; frailty index [1.5-4.4: +1; 4.5-9.5: +2; >9.5: +3]; women: +1; dyslipidemia: -1; obesity: -1; anemia: +8; thrombocytopenia: +2; cancer: +2; abnormal kidney function: +4; glomerular disease: -1; vascular kidney disease: -1; diabetic kidney disease: -1; autoimmune disease: +2; vasculitis: +5; hematologic disease: +2; thrombotic microangiopathy: +4; amyloidosis: -2; other kidney diagnosis: -1) + a constant of 5. The risk of bleeding went from 0.4% (lowest score group =0-4 points) to 33% (highest score group ≥35 points). Major bleeding was an independent risk of death (500 of 52,138 deaths: bleeding: 81 of 2765 [3%]; no bleeding: 419 of 49,373 [0.9%]; odds ratio, 1.95; 95% confidence interval, 1.50 to 2.54; <0.001).
The risk of major bleeding after percutaneous native kidney biopsy may be higher than generally thought and is associated with a twofold higher risk of death. It varies widely but can be estimated with a score useful for shared decision making and procedure choice.
经皮肾活检后发生大出血的风险通常被认为较低，但仍难以准确预测。本研究旨在评估大出血风险，并建立术前出血风险评分。
设计、地点、参与者和测量：本研究为回顾性队列研究，纳入了 2010 年至 2018 年期间在法国进行经皮肾活检的 52138 例患者。测量指标包括活检后第 8 天的主要出血（输血、血肿/血肿、血管造影介入或肾切除术）和第 30 天的死亡风险。暴露和结局通过诊断代码定义。
52138 例患者中 2765 例（5%）发生大出血（输血：5%；血管造影介入：0.4%；肾切除术：0.1%）。19 种诊断与大出血相关。计算出血风险评分（Charlson 指数[2-4：+1；5 和 6：+2；>6：+3]；虚弱指数[1.5-4.4：+1；4.5-9.5：+2；>9.5：+3]；女性：+1；血脂异常：-1；肥胖：-1；贫血：+8；血小板减少：+2；癌症：+2；肾功能异常：+4；肾小球疾病：-1；血管性肾病：-1；糖尿病肾病：-1；自身免疫性疾病：+2；血管炎：+5；血液系统疾病：+2；血栓性微血管病：+4；淀粉样变性：-2；其他肾脏诊断：-1）+常数 5。出血风险从 0.4%（评分最低组=0-4 分）上升至 33%（评分最高组≥35 分）。大出血是死亡的独立危险因素（52138 例死亡患者中：出血：2765 例中的 81 例[3%]；无出血：49373 例中的 419 例[0.9%]；优势比，1.95；95%置信区间，1.50 至 2.54；<0.001）。
经皮肾活检后发生大出血的风险可能高于普遍认为的风险，且与死亡风险增加两倍相关。风险差异较大，但可通过评分估计，有助于决策和手术选择。
