Risk of intracranial hemorrhage in critically ill ACLF patients: a retrospective single center cohort study.

Abstract

Background: Critically ill patients with liver cirrhosis present numerous challenges in clinical evaluation of bleeding risk. Their deficiencies in both pro- and anticoagulant factors result in a particularly fragile hemostatic system and bleeding complications. While the risk of the particular bleeding complication of intracerebral hemorrhage (ICH) is a major clinical concern, the question of whether ICH occurs more frequently in patients with acute-on-chronic liver failure (ACLF) compared to a control group and which parameters predict cerebral bleeding, remain unresolved and was the aim of this study.

Methods: One hundred two critically ill ACLF patients and 166 patients in the control group were included retrospectively. Clinical parameters and occurrence of spontaneous ICH were compared to controls.

Results: Cerebral computer tomography detected ICH in 15 out of 102 patients (14.7%) in the ACLF group compared to 16 out of 166 patients (9.6%) in the control group. While patients in the ACLF group exhibited prolonged prothrombin time (pTT) (median [IQR]: (57 [45-71] s vs. 42 [35-52] s, p < 0.001) and higher INR values (1.9 [1.5-2.4] vs. 1.2 [1.1-1.4], p < 0.001), significantly lower platelet count compared to control group (43 [24-64] × 10³/µL vs. 87 [39-159] × 10³/µL, p < 0.001) as risk factors for cerebral bleeding, statistical analysis revealed a trend towards a higher incidence among patients in the ACLF group compared to controls (OR: 1.61, chi-square-test, p-value = 0.24).

Conclusions: Although statistical analysis showed a tendency to a higher incidence of ICH in the ACLF group compared to controls, ICH did not occur significantly more frequently in patients with ACLF. While no correlation was shown between the occurrence of ICH and high systolic blood pressure or dysregulated INR and pTT, low platelet counts were associated with spontaneous ICH in both groups.