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Thromb Haemost 2022; 122(06): 1006-1016
DOI: 10.1055/a-1667-7293
Stroke, Systemic or Venous Thromboembolism

Prevalence of Bleeding and Thrombosis in Critically Ill Patients with Chronic Liver Disease

Tsai-Wing Ow
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
,
Evangelia Fatourou
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
,
Liane Rabinowich
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
,
Bente van den Boom
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
2   Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
,
Shrijit Nair
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
,
Vishal C. Patel
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
3   School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Strand, London, United Kingdom
4   Institute of Hepatology, Foundation for Liver Research, London, United Kingdom
,
Brian Hogan
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
,
Mark McPhail
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
3   School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Strand, London, United Kingdom
,
Lara N. Roberts    *
5   Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
,
William Bernal   *
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
3   School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Strand, London, United Kingdom
› Author Affiliations Funding None.
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Abstract

Introduction Hemorrhage and venous thromboembolism (VTE) are recognized complications of chronic liver disease (CLD), but their prevalence and risk factors in critically ill patients are uncertain.

Patients and Methods We studied a retrospective cohort of patients with CLD nonelectively admitted to a specialist intensive care unit (ICU) determining the prevalence and timing of major bleeding and VTE (early, present on admission/diagnosed within 48 hours; later, diagnosed >48 hours post-ICU admission). Associations with baseline clinical and laboratory characteristics, multiorgan failure (MOF), blood product administration, and mortality were explored. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression.

Results Of 623 patients with median age 52, bleeding (>48 hours after admission) occurred in 87 (14%) patients. Bleeding was associated with greater illness severity and increased mortality. Gastrointestinal bleeding accounted for 72% of events, secondary to portal hypertension in >90%. Procedure-related bleeding was uncommon. VTE occurred in 125 (20%) patients: early VTE in 80 (13%) and involving the portal vein in 85%. Later VTE affected 45 (7.2%) patients. Hepatocellular carcinoma (HCC) and nonalcoholic liver disease were independently associated with early VTE (OR: 2.79, 95% CI: 1.5–5.2 and OR: 2.32, 95% CI: 1.4–3.9, respectively), and HCC, sepsis, and cryoprecipitate use with late VTE (OR: 2.45, 95% CI: 1.11–5.43; OR: 2.26, 95% CI: 1.2–4.3; and OR: 2.60, 95% CI: 1.3–5.1).

Conclusion VTE was prevalent on admission to critical care and less commonly developed later. Bleeding was associated with MOF and increased mortality. Severe MOF was not associated with an increased rate of VTE which was linked with HCC, and specific etiologies of CLD.

Keywords

liver disease - critical care - hemorrhage - venous thromboembolism

Author Contributions

W.B. conceived and supervised the study and design, data analysis and interpretation, and critical review of the paper. T.-W.O. led data collection, interpretation, and writing of the manuscript. L.N.R. contributed to study design, data interpretation, and writing of the manuscript. E.F., L.R., S.N., and B.v.d.B. collected data. V.C.P., B.H., and M.M. interpreted the data and critically reviewed the manuscript. All authors revised and approved the final submission.


* Co-joint senior authors.


Supplementary Material



Publication History

Received: 17 March 2021

Accepted: 10 October 2021

Accepted Manuscript online:
12 October 2021

Article published online:
28 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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