Internal Medicine Department, HM Sanchinarro, HM Hospitales, C/Oña 10, 28050, Madrid, Spain.
Department of Medical Oncology, Hospital Clínic, Barcelona, Spain.
Intern Emerg Med. 2022 Apr;17(3):725-734. doi: 10.1007/s11739-021-02858-x. Epub 2021 Oct 9.
The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patients with venous thromboembolism (VTE) has not been evaluated. Data from patients in RIETE (Registro Informatizado Enfermedad TromboEmbólica) were used to assess the association between elevated liver enzymes or FIB-4 levels and the rates of major bleeding or death in apparent liver disease-free patients with acute VTE under anticoagulation therapy. A total of 6206 patients with acute VTE and without liver disease were included. Of them, 92 patients had major bleeding and 168 died under anticoagulation therapy. On multivariable analysis, patients with elevated liver enzymes were at increased mortality risk (HR: 1.58; 95% CI: 1.10-2.28), while those with FIB-4 levels > 2.67 points were at increased risk for major bleeding (HR: 1.69; 95% CI: 1.04-2.74). Evaluation of liver enzymes and FIB-4 index at baseline in liver disease-free patients with VTE may provide additional information on the risk for major bleeding or death during anticoagulation.
尚未评估升高的肝酶或 FIB-4（纤维化指数 4）与静脉血栓栓塞症（VTE）患者结局之间的关系。利用 RIETE（血栓栓塞登记处）患者的数据，评估了在接受抗凝治疗的无明显肝脏疾病的急性 VTE 患者中，升高的肝酶或 FIB-4 水平与大出血或死亡发生率之间的关系。共纳入 6206 例无肝脏疾病的急性 VTE 患者。其中，92 例患者在抗凝治疗期间发生大出血，168 例患者死亡。多变量分析显示，肝酶升高的患者死亡风险增加（HR：1.58；95%CI：1.10-2.28），而 FIB-4 水平>2.67 分的患者大出血风险增加（HR：1.69；95%CI：1.04-2.74）。在无肝脏疾病的 VTE 患者中，基线时评估肝酶和 FIB-4 指数可能会提供更多关于抗凝期间大出血或死亡风险的信息。
