Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
Int Urol Nephrol. 2022 Feb;54(2):343-348. doi: 10.1007/s11255-021-02874-y. Epub 2021 Apr 29.
Individuals undergoing kidney biopsy are increasingly older and may have concurrent illnesses that cause deranged hematological and renal parameters that are associated with post-biopsy bleeding. We aimed to develop a clinical risk model to quantify bleeding risks in high-risk individuals with multiple risk factors.
Single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 2 mg/dL (176 µmol/L) and had ultrasound-guided percutaneous native kidney biopsies between June 2011 and July 2015 in our tertiary referral center. The primary outcome was major bleeding, defined as need for red cell transfusion, radiological or surgical intervention, or if bleeding led to death within 7 days after kidney biopsy.
Among 184 native kidney biopsies with serum creatinine ≥ 2 mg/dL, median age was 54.1 years and eGFR was 18.8 ml/min/1.73 m. Major bleeding occurred in 19 biopsies (10.3%). Multivariate analysis accounting for age, weight, hemoglobin, platelet, prothrombin time and urea found that higher hemoglobin (adjusted OR 0.51, 95% CI 0.33-0.79, p = 0.003) and platelet (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.01) were independently associated with reduced major bleeding. A risk model that included (1) age ≥ 62 years old, (2) hemoglobin < 10 g/dL and (3) platelets ≤ 216 × 10/L as categorical variables predicted major bleeding post-biopsy.
We developed a risk model that included multiple risk factors to quantify bleeding risks in native kidney biopsies with renal impairment.
接受肾活检的患者年龄越来越大，可能同时患有导致血液学和肾功能参数异常的疾病，这些异常与活检后出血有关。我们旨在开发一种临床风险模型，以量化伴有多种危险因素的高危人群的出血风险。
这是一项单中心回顾性队列研究，纳入了 2011 年 6 月至 2015 年 7 月期间在我们的三级转诊中心接受血清肌酐≥2mg/dL（176µmol/L）和超声引导下经皮肾活检的连续成年患者。主要结局是主要出血，定义为需要红细胞输注、影像学或手术干预，或如果出血导致肾活检后 7 天内死亡。
在 184 例血清肌酐≥2mg/dL 的肾活检中，中位年龄为 54.1 岁，eGFR 为 18.8ml/min/1.73m。19 例（10.3%）发生主要出血。多变量分析考虑了年龄、体重、血红蛋白、血小板、凝血酶原时间和尿素，发现血红蛋白较高（校正 OR 0.51，95%CI 0.33-0.79，p=0.003）和血小板较高（校正 OR 0.99，95%CI 0.98-0.99，p=0.01）与降低主要出血独立相关。一个包括（1）年龄≥62 岁，（2）血红蛋白<10g/dL 和（3）血小板≤216×10/L 作为分类变量的风险模型预测了肾活检后的主要出血。
我们开发了一种风险模型，其中包括多个危险因素，以量化伴有肾功能损害的肾活检中的出血风险。
