ST. LOUIS — A recent study looked at risk factors for non-variceal bleeding within the first year after diagnosis of chronic liver disease in veterans.
“Non-variceal hemorrhage in patients with chronic liver disease (CLD) increases morbidity, mortality, and healthcare costs,” wrote researchers from Washington University in St Louis, MO, and the John Cochran VAMC in St. Louis.
Data is limited on risk factors for non-variceal hemorrhage in the CLD population. The study team sought to assess the predictive value of various clinical and laboratory parameters for non-variceal hemorrhage in CLD patients. Their results were published in the Journal of Hematology.1
The retrospective cohort study was of U.S. veterans diagnosed with CLD between 2002 and 2018 within the VHA database. Candidate variables were derived from existing risk prediction models for hemorrhage, risk calculators for severity of liver disease, Charlson index of prognostic comorbidities and prior literature. Competing risk analysis was employed to study the relationship between putative risk factors and incidence of non-variceal hemorrhage in patients with CLD.
Results indicated that, of 15,183 CLD patients with no history of cancer or anticoagulation use, 674 experienced non-variceal hemorrhage within one year of CLD diagnosis. In multivariable analysis, 11 of the 26 candidate variables independently predicted non-variceal hemorrhage. Those included:
- race,
- international normalized ratio (INR) > 1.5, bilirubin ≥ 2 mg/dL,
- albumin ≤ 3.5 g/dL,
- anemia,
- alcohol abuse,
- antiplatelet therapy,
- chronic kidney disease,
- dementia,
- proton pump inhibitor prescription and
- recent infection.
“In this study of almost 15,000 veterans, risk factors for non-variceal bleeding within the first year after diagnosis of CLD included non-Caucasian race, laboratory parameters indicating severe liver disease and recent infection in addition to the risk factors for bleeding observed in a general non-CLD population,” the authors concluded.
- Afzal A, Kesavan P, Suhong L, Gage BF, Korenblat K, Schoen M, Sanfilippo K. Predictors of Non-Variceal Hemorrhage in a National Cohort of Patients With Chronic Liver Disease. J Hematol. 2024 Jun;13(3):71-78. doi: 10.14740/jh1214. Epub 2024 Jun 28. PMID: 38993731; PMCID: PMC11236355.