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Risks and predicting factors of bleeding complications in hepatitis B virus-related acute-on-chronic liver failure

Hong-Ying Guo1, Zheng-Guo Zhang1, Yu-Yi Zhang1

  • 1Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.

The Turkish Journal of Gastroenterology : the Official Journal of Turkish Society of Gastroenterology
|October 22, 2020
PubMed

Insights

Patients with acute-on-chronic liver failure (ACLF) experiencing bleeding complications had lower fibrinogen and coagulation factors. These factors, along with cirrhosis, predict bleeding risk and impact survival rates in ACLF patients.

Area of Science:

  • Hepatology
  • Internal Medicine
  • Critical Care Medicine

Background:

  • Acute-on-chronic liver failure (ACLF) presents significant challenges in patient management.
  • Bleeding complications are a major concern in ACLF, impacting prognosis and requiring effective prevention strategies.

Purpose of the Study:

  • To identify risk and predictive factors for bleeding complications in hospitalized ACLF patients.
  • To provide evidence for early prevention and prognostic evaluation of bleeding events in ACLF.

Main Methods:

  • Retrospective analysis of 101 hospitalized ACLF patients (January 2014 - December 2015).
  • Patients categorized into bleeding (n=38) and nonbleeding (n=63) groups.
  • Comparison of demographic data and laboratory tests, including coagulation factors and creatinine; logistic regression analysis performed.

Main Results:

  • 37.62% of ACLF patients experienced bleeding complications (25.74% spontaneous, 11.88% postprocedural).
  • Bleeding group showed lower platelet, fibrinogen, factor V, and factor VII levels; higher serum creatinine; and higher proportion of cirrhosis.
  • Cirrhosis, low fibrinogen, and low factor VII were significant predictors of bleeding complications.

Conclusions:

  • Liver cirrhosis, reduced fibrinogen, and diminished coagulation factor activity are associated with increased bleeding risk in ACLF.
  • Bleeding complications significantly impair the 90-day survival rate in patients with ACLF.
  • Identifying these risk factors aids in the prognostic evaluation and management of bleeding in ACLF.
Abstract

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