Usefulness of Spleen Index and Alkaline Phosphatase Level for Predicting Post-Liver Biopsy Bleeding

Abstract

Aims

The significance of liver biopsy is increasing with an increase in chronic liver disease and gene panel testing. Although non-invasive methods such as elastography and biomarkers assess liver fibrosis, biopsy remains the definitive diagnostic gold standard. We evaluated the predictors of bleeding complications in liver biopsies.

Methods and Results

A total of 697 patients were enrolled in this study between May 2017 and October 2022. We examined bleeding complications and procedures following liver biopsy and the liver biopsy needle size, blood test results, and spleen index to determine factors related to bleeding complications. Bleeding complications occurred in 23 patients (3.3%), including 20 cases at the liver puncture site, two instances of biliary bleeding, and one intercostal artery injury. The treatments varied and included hepatic arterial embolization (2 patients, 0.3%), blood transfusion therapy (3 patients, 0.4%), radiofrequency ablation (2 patients, 0.3%), endoscopic nasobiliary drainage (1 patient, 0.1%), and other treatments. In multivariate and ROC analyzes, a higher spleen index (Odds ratio: 1.13 [1.07–1.20], AUC: 0.74, optimal cut-off value: 16.2, sensitivity: 0.74, specificity: 0.64) and ALP level (Odds ratio: 1.00 [1.00–1.01], AUC: 0.71, optimal cut-off value: 94.5, sensitivity: 0.83, specificity: 0.49) were associated with an increased risk of bleeding. Other significant factors influencing bleeding included age, PT-INR, needle size, and Child–Pugh score.

Conclusions

The identified risk factors included spleen index and ALP level, particularly in relation to bleeding complications during liver biopsy. Therefore, these predictors should be considered before performing a liver biopsy.