Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA.
Department of Internal Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
Eur Radiol. 2024 Oct;34(10):6416-6424. doi: 10.1007/s00330-024-10692-w. Epub 2024 Mar 14.
To determine whether international normalized ratio (INR), bilirubin, and creatinine predict bleeding risk following percutaneous liver biopsy.
A total of 870 consecutive patients (age 53 ± 14 years; 53% (459/870) male) undergoing non-targeted, ultrasound-guided, percutaneous liver biopsy at a single tertiary center from 01/2016 to 12/2019 were retrospectively reviewed. Results were analyzed using descriptive statistics and logistic regression models to evaluate the relationship between individual and combined laboratory values, and post-biopsy bleeding risk. Receiver operating characteristic (ROC) curves and area under ROC (AUC) curves were constructed to evaluate predictive ability.
Post-biopsy bleeding occurred in 2.0% (17/870) of patients, with 0.8% (7/870) requiring intervention. The highest INR within 3 months preceding biopsy demonstrated the best predictive ability for post-biopsy bleeding and was superior to the most recent INR (AUC = 0.79 vs 0.61, p = 0.003). Total bilirubin is an independent predictor of bleeding (AUC = 0.73) and better than the most recent INR (0.61). Multivariate regression analysis of the highest INR and total bilirubin together yielded no improvement in predictive performance compared to INR alone (0.80 vs 0.79). The MELD score calculated using the highest INR (AUC = 0.79) and most recent INR (AUC = 0.74) were similar in their predictive performance. Creatinine is a poor predictor of bleeding (AUC = 0.61). Threshold analyses demonstrate an INR of > 1.8 to have the highest predictive accuracy for bleeding.
The highest INR in 3 months preceding ultrasound-guided percutaneous liver biopsy is associated with, and a better predictor for, post-procedural bleeding than the most recent INR and should be considered in patient risk stratification.
Despite correction of coagulopathic indices, the highest international normalized ratio within the 3 months preceding percutaneous liver biopsy is associated with, and a better predictor for, bleeding and should considered in clinical decision-making and determining biopsy approach.
• Bleeding occurred in 2% of patients following ultrasound-guided liver biopsy, and was non-trivial in 41% of those patients who needed additional intervention and had an associated 23% 30-day mortality rate. • The highest INR within 3 months preceding biopsy (AUC = 0.79) is a better predictor of bleeding than the most recent INR (AUC = 0.61). • The MELD score is associated with post-procedural bleeding, but with variable predictive performance largely driven by its individual laboratory components.
确定国际标准化比值（INR）、胆红素和肌酐是否能预测经皮肝活检后的出血风险。
回顾性分析 2016 年 1 月至 2019 年 12 月在一家三级中心进行的非靶向、超声引导下经皮肝活检的 870 例连续患者（年龄 53±14 岁；53%（459/870）为男性）。使用描述性统计和逻辑回归模型分析结果，以评估个体和联合实验室值与活检后出血风险之间的关系。绘制受试者工作特征（ROC）曲线和 ROC 曲线下面积（AUC）以评估预测能力。
活检后出血发生率为 2.0%（17/870），其中 0.8%（7/870）需要干预。活检前 3 个月内最高 INR 对活检后出血具有最佳的预测能力，优于最近的 INR（AUC=0.79 与 0.61，p=0.003）。总胆红素是出血的独立预测因子（AUC=0.73），优于最近的 INR（0.61）。与 INR 相比，最高 INR 和总胆红素的多元回归分析并没有提高预测性能（0.80 与 0.79）。使用最高 INR 计算的 MELD 评分（AUC=0.79）和使用最近 INR 计算的 MELD 评分（AUC=0.74）在预测性能上相似。肌酐是出血的一个较差的预测因子（AUC=0.61）。阈值分析表明 INR>1.8 对出血具有最高的预测准确性。
与最近的 INR 相比，超声引导经皮肝活检前 3 个月内的最高 INR 与术后出血相关，并且是更好的预测因子，应在患者风险分层中考虑。
尽管纠正了凝血异常指数，但在经皮肝活检前 3 个月内最高的 INR 与出血相关，并且是更好的预测因子，应在临床决策和确定活检方法中考虑。
超声引导下肝活检后有 2%的患者发生出血，其中 41%需要额外干预的患者出血严重，且有 23%的患者在 30 天内死亡。
活检前 3 个月内的最高 INR（AUC=0.79）是出血的更好预测因子，优于最近的 INR（AUC=0.61）。
MELD 评分与术后出血相关，但预测性能存在差异，主要由其个体实验室成分驱动。
