Bleeding complications in acute liver failure

R. Todd Stravitz, Caitlyn Ellerbe, Valerie Durkalski, Michael Schilsky, Robert J. Fontana, Carolyn Peterseim, William M. Lee

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

In patients with acute liver failure (ALF), elevated prothrombin time and thrombocytopenia can fuel a perception of a bleeding tendency. However, the incidence, site, risk factors, and clinical significance of bleeding complications have not been quantified in a large cohort of patients with ALF. We studied 1,770 adult patients enrolled in the ALF Study Group Registry between 1998 and 2016. Bleeding complications and blood component transfusions were collected for 7 days after admission. The relationship of bleeding complications to 21-day mortality was assessed. Despite a median international normalized ratio of 2.7 and platelet count of 96×109/L on admission, bleeding complications were observed in only 187 patients (11%), including 173 spontaneous and 22 postprocedural bleeding episodes. Eighty-four percent of spontaneous bleeding episodes were from an upper gastrointestinal source and rarely resulted in red blood cell transfusion. Twenty patients experienced an intracranial bleed; half of these occurred spontaneously and half after intracranial pressure monitor placement, and this was the proximate cause of death in 20% and 50%, respectively. Bleeders and patients who received red blood cell transfusions were more acutely ill from extrahepatic organ system failure but not from hepatocellular failure. Consistent with this observation, bleeding complications were associated with lower platelet counts but not higher international normalized ratio. Transfusion of any blood component was associated with nearly 2-fold increased death or need for liver transplantation at day 21, but bleeding complications were the proximate cause of death in only 5% of cases. Conclusions. Despite a perceived bleeding diathesis, clinically significant bleeding is uncommon in patients with ALF; bleeding complications in patients with ALF are markers of severe systemic inflammation rather than of coagulopathy and so portend a poor prognosis. (Hepatology 2017)

Original languageEnglish (US)
JournalHepatology
DOIs
StateAccepted/In press - Jan 1 2018

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Acute Liver Failure
Hemorrhage
Blood Component Transfusion
Erythrocyte Transfusion
International Normalized Ratio
Platelet Count
Cause of Death
Prothrombin Time
Disease Susceptibility
Intracranial Pressure
Gastroenterology
Thrombocytopenia
Liver Transplantation
Registries

ASJC Scopus subject areas

  • Hepatology

Cite this

Stravitz, R. T., Ellerbe, C., Durkalski, V., Schilsky, M., Fontana, R. J., Peterseim, C., & Lee, W. M. (Accepted/In press). Bleeding complications in acute liver failure. Hepatology. https://doi.org/10.1002/hep.29694

Bleeding complications in acute liver failure. / Stravitz, R. Todd; Ellerbe, Caitlyn; Durkalski, Valerie; Schilsky, Michael; Fontana, Robert J.; Peterseim, Carolyn; Lee, William M.

In: Hepatology, 01.01.2018.

Research output: Contribution to journalArticle

Stravitz, RT, Ellerbe, C, Durkalski, V, Schilsky, M, Fontana, RJ, Peterseim, C & Lee, WM 2018, 'Bleeding complications in acute liver failure', Hepatology. https://doi.org/10.1002/hep.29694
Stravitz RT, Ellerbe C, Durkalski V, Schilsky M, Fontana RJ, Peterseim C et al. Bleeding complications in acute liver failure. Hepatology. 2018 Jan 1. https://doi.org/10.1002/hep.29694
Stravitz, R. Todd ; Ellerbe, Caitlyn ; Durkalski, Valerie ; Schilsky, Michael ; Fontana, Robert J. ; Peterseim, Carolyn ; Lee, William M. / Bleeding complications in acute liver failure. In: Hepatology. 2018.
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