Unravelling risk factors for delayed bleeding following ultrasonography-guided liver biopsy: a retrospective analysis

Percutaneous liver puncture remains the gold standard for diagnosis of liver lesions, though image-guided techniques reduce the incidence of complications, there remains a risk of severe delayed bleeding. This study aimed to analyze the risk factors associated with delayed bleeding complications after ultrasonography-guided liver biopsy.

In this retrospective study, we enrolled a total of 642 patients who underwent ultrasonography-guided percutaneous liver biopsy at our institution between January 2022 and December 2023. Data on patient characteristics, laboratory results, radiographic findings, bleeding complications, and treatments were extracted from the electronic medical records (EMR) system of the hospital. This study aimed to identify the differences in clinical characteristics between post-biopsy bleeding and non-bleeding groups as well as between early and delayed post-biopsy bleeding groups. Propensity score matching (PSM) algorithms were employed to mitigate the impact of sample size on the results.

After exclusion screening, a total of 627 patients were included in this study. Of these, 233 (37.16%) were men and 394 (62.84%) were women. The primary reason for liver puncture was liver transplantation (45.29%). Eleven cases of post-biopsy bleeding were observed, where eight were mild (72.73% of total cases exhibiting bleeding and 1.27% of total punctures) and three were serious (27.27% of total cases displaying bleeding and 0.48% of total punctures). Serious bleeding was delayed in all patients exhibiting bleeding. No bleeding-related risk factors were identified in either the overall cohort or the PSM cohort. Nevertheless, our findings indicate that patients with delayed bleeding exhibited lower platelet counts and were more likely to present with hydrothorax or ascites.

There were no statistically significant differences in any of the baseline characteristics between patients with and without post-biopsy bleeding. However, when patients presented with platelets below the normal range in conjunction with hydrothorax or ascites, there was an increased risk of delayed bleeding.