Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study

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dc.contributor.authorIntagliata, Nicolas M.
dc.contributor.authorRahimi, Robert S.
dc.contributor.authorHiguera-de-la-Tijera, Fatima
dc.contributor.authorSimonetto, Douglas A.
dc.contributor.authorFarias, Alberto Queiroz
dc.contributor.authorMazo, Daniel F.
dc.contributor.authorBoike, Justin R.
dc.contributor.authorStine, Jonathan G.
dc.contributor.authorSerper, Marina
dc.contributor.authorPereira, Gustavo
dc.contributor.authorMattos, Angelo Z.
dc.contributor.authorMarciano, Sebastian
dc.contributor.authorDavis, Jessica P. E.
dc.contributor.authorBenitez, Carlos
dc.contributor.authorChadha, Ryan
dc.contributor.authorMendez-Sanchez, Nahum
dc.contributor.authordeLemos, Andrew S.
dc.contributor.authorMohanty, Arpan
dc.contributor.authorDirchwolf, Melisa
dc.contributor.authorFortune, Brett E.
dc.contributor.authorNorthup, Patrick G.
dc.contributor.authorPatrie, James T.
dc.contributor.authorCaldwell, Stephen H.
dc.date.accessioned2025-01-20T17:28:08Z
dc.date.available2025-01-20T17:28:08Z
dc.date.issued2023
dc.description.abstractBACKGROUND & AIMS: Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. METHODS: Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. RESULTS: A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). CONCLUSIONS: Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy.
dc.fuente.origenWOS
dc.identifier.doi10.1053/j.gastro.2023.05.046
dc.identifier.eissn1528-0012
dc.identifier.issn0016-5085
dc.identifier.urihttps://doi.org/10.1053/j.gastro.2023.05.046
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/91582
dc.identifier.wosidWOS:001087558700001
dc.issue.numero3
dc.language.isoen
dc.pagina.final732
dc.pagina.inicio717
dc.revistaGastroenterology
dc.rightsacceso restringido
dc.subjectHemostasis
dc.subjectObesity
dc.subjectProphylaxis
dc.subjectRisk
dc.subjectCirrhosis
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleProcedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study
dc.typeartículo
dc.volumen165
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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