Division of Surgery, DAICIM Foundation, Buenos Aires, Argentina; Division of Surgery, Minimally Invasive Surgery, Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina; Division of Surgery, University of Buenos Aires, Buenos Aires, Argentina.
Division of Surgery, DAICIM Foundation, Buenos Aires, Argentina.
J Vasc Interv Radiol. 2022 Aug;33(8):919-925.e2. doi: 10.1016/j.jvir.2022.04.032. Epub 2022 Apr 30.
To determine risk factors (RFs) for hemorrhagic adverse events (AEs) associated with percutaneous transhepatic biliary drainage (PTBD) and to develop a risk assessment model.
This was a multicenter, prospective, case control study between 2015 and 2020. Adults with an indication for PTBD were included. Patients who had undergone recent previous drainage procedures were excluded. Multiple variables were controlled. The exposure variables were the number of capsular punctures and passes (using the same puncture). A multivariate analysis was performed (logistic regression analysis).
A total of 304 patients (mean age, 63 years ± 14 [range, 23-87 years]; female, 53.5%) were included. Hemorrhagic AEs occurred in 13.5% (n = 41) of the patients, and 3.0% (n = 9) of the cases were severe. Univariate analysis showed that the following variables were not associated with hemorrhagic AEs: age, sex, bilirubin and hemoglobin levels, type of pathology, portal hypertension, location of vascular punctures, ascites, nondilated bile duct, intrahepatic tumors, catheter features, blood pressure, antiplatelet drug use, and tract embolization. Multivariate analysis showed that number of punctures (odds ratio [OR], 2.5; P = .055), vascular punctures (OR, 4.1; P = .007), fatty liver or cirrhosis (OR, 3.7; P = .021), and intrahepatic tumor obstruction (Bismuth ≥ 2; OR, 2.4; P = .064) were associated with hemorrhagic AEs. Patients with corrected coagulopathies had fewer hemorrhagic AEs (OR, -5.5; P = .026). The predictability was 88.2%. The area under the curve was 0.56 (95% confidence interval, 0.50-0.61).
Preprocedural and intraprocedural RFs were identified in relation to hemorrhage with PTBD. AE risk assessment information may be valuable for prediction and management of hemorrhagic AEs.
确定经皮经肝胆道引流（PTBD）相关出血不良事件（AE）的危险因素（RFs），并建立风险评估模型。
这是一项 2015 年至 2020 年期间进行的多中心前瞻性病例对照研究。纳入有 PTBD 适应证的成年人。排除近期有引流史的患者。控制了多个变量。暴露变量是包膜穿刺和通过的次数（使用相同的穿刺点）。进行了多变量分析（logistic 回归分析）。
共纳入 304 例患者（平均年龄 63 岁±14 岁[范围：23-87 岁]；女性占 53.5%）。13.5%（n=41）的患者发生出血性 AE，3.0%（n=9）的病例为严重出血。单因素分析显示，以下变量与出血性 AE 无关：年龄、性别、胆红素和血红蛋白水平、病变类型、门静脉高压、血管穿刺部位、腹水、胆管不扩张、肝内肿瘤、导管特征、血压、抗血小板药物使用和通道栓塞。多因素分析显示，穿刺次数（优势比[OR]，2.5；P=0.055）、血管穿刺（OR，4.1；P=0.007）、脂肪肝或肝硬化（OR，3.7；P=0.021）和肝内肿瘤阻塞（Bismuth 分级≥2；OR，2.4；P=0.064）与出血性 AE 相关。纠正凝血功能障碍的患者出血性 AE 较少（OR，-5.5；P=0.026）。预测率为 88.2%。曲线下面积为 0.56（95%置信区间，0.50-0.61）。
PTBD 相关出血的术前和术中有明确的 RFs。AE 风险评估信息可能对预测和管理出血性 AE 有价值。
