Background and Aims: Management of ultrasound (US)-guided percutaneous liver biopsy (PLB) lacks standardisation. Despite the low risk of major complications (< 1%), repeated blood counts and up to 4 h of in-hospital observation are typically recommended. We aimed to assess complication rates and predictors in a large cohort of patients undergoing US-PLB across three Italian tertiary centres. We included all patients undergoing US-PLB from January 2018 to December 2023. We collected clinical, biochemical and procedural features (needle type, insertions number, observation time and antiplatelet/anticoagulant regimens). Safety was assessed by the incidence of pain and major complications, including vasovagal reaction, bleeding, pneumothorax, shock, hospitalisation and death. Approach and Results: Among 1838 patients (mean age 55.1 years, 46.1% females, mean BMI 25.1 kg/m2, 74% parenchymal PLB), few were on anticoagulant/antiplatelet therapy (4.2%/16.2%); mean platelet count and PT INR were 209.7 × 103/mm3 and 1.04; 17 patients (0.9%) received prophylactic therapy (blood components, thrombopoietin receptor agonists or vitamin K). Needle aspiration was predominant (92%). During a mean time of observation of 5.4 ± 2.0 h, 134/1838 patients reported pain (7.4%). Major complications were few (26, 1.4%), with 14 episodes of transient hypotension (0.8%); 10 bleeding events (0.5%); 1 pneumothorax; 1 abscess formation; 1 haemobilia; and 1 episode of chest pain. Hospitalisation was rare (12, 0.7%), primarily for bleeding management. No fatalities were recorded. Pain was the sole significant independent predictor of major complications (18/26, HR 30.6, p < 0.05), particularly when reported within the first hour post-procedure (15/18, 83.3%). Conclusions: Major complications following US-PLB are few and strongly associated with early post-procedural pain. In the absence of pain within the first hour, extended monitoring may be unnecessary, allowing for earlier patient discharge.
Incidence and Predictors of Complications Following Percutaneous Liver Biopsy: A Large Italian Multicentre Study
Colapietro, Francesca;Lleo, Ana;Aghemo, Alessio
2025-01-01
Abstract
Background and Aims: Management of ultrasound (US)-guided percutaneous liver biopsy (PLB) lacks standardisation. Despite the low risk of major complications (< 1%), repeated blood counts and up to 4 h of in-hospital observation are typically recommended. We aimed to assess complication rates and predictors in a large cohort of patients undergoing US-PLB across three Italian tertiary centres. We included all patients undergoing US-PLB from January 2018 to December 2023. We collected clinical, biochemical and procedural features (needle type, insertions number, observation time and antiplatelet/anticoagulant regimens). Safety was assessed by the incidence of pain and major complications, including vasovagal reaction, bleeding, pneumothorax, shock, hospitalisation and death. Approach and Results: Among 1838 patients (mean age 55.1 years, 46.1% females, mean BMI 25.1 kg/m2, 74% parenchymal PLB), few were on anticoagulant/antiplatelet therapy (4.2%/16.2%); mean platelet count and PT INR were 209.7 × 103/mm3 and 1.04; 17 patients (0.9%) received prophylactic therapy (blood components, thrombopoietin receptor agonists or vitamin K). Needle aspiration was predominant (92%). During a mean time of observation of 5.4 ± 2.0 h, 134/1838 patients reported pain (7.4%). Major complications were few (26, 1.4%), with 14 episodes of transient hypotension (0.8%); 10 bleeding events (0.5%); 1 pneumothorax; 1 abscess formation; 1 haemobilia; and 1 episode of chest pain. Hospitalisation was rare (12, 0.7%), primarily for bleeding management. No fatalities were recorded. Pain was the sole significant independent predictor of major complications (18/26, HR 30.6, p < 0.05), particularly when reported within the first hour post-procedure (15/18, 83.3%). Conclusions: Major complications following US-PLB are few and strongly associated with early post-procedural pain. In the absence of pain within the first hour, extended monitoring may be unnecessary, allowing for earlier patient discharge.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
