Incidence and Predictors of Complications Following Percutaneous Liver Biopsy: A Large Italian Multicentre Study

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.