Background: Patients with chronic liver disease (CLD) frequently experience non-variceal hemorrhage, which results in considerable morbidity, mortality, and healthcare costs. Available literature focuses on the prevention of variceal hemorrhage; however, studies identifying risk factors for non-variceal hemorrhage have been limited.

Aims: We assessed the role of various clinical and laboratory parameters in predicting the risk of non-variceal hemorrhage among CLD patients.

Methods: This is a large, retrospective cohort study of U.S. veterans diagnosed with CLD between October 1, 2002 and September 30, 2016. We excluded patients with a history of malignancy, artificial heart valves, atrial fibrillation, prior venous thromboembolism, and anticoagulation. We selected candidate predictors from the HEMORR₂HAGES, HAS-BLED, and Child-Pugh risk prediction models. When appropriate, variables were analyzed as time-varying. We used competing risk analysis by methods of Fine and Grey to identify predictors of non-variceal hemorrhage within one year of CLD diagnosis.

Results: A total of 14,281 CLD patients were included in the study, and 576 hemorrhagic events were identified within one year of follow-up (Table 1). Most of the events occurred in the upper gastrointestinal (GI) tract (381), followed by lower GI tract (104), intracranial (35), and nasal/respiratory (31) hemorrhages. In competing risk analysis (Table 2), the following predictors were independently associated with non-variceal hemorrhage: elevated INR between 1.5 and 3, aspirin use, high bilirubin, low albumin, low glomerular filtration rate, prior hemorrhage, anemia, alcohol abuse, hemi- or paraplegia, and dementia.
Demographic and Clinical Characteristics Comparison for CLD Patients Diagnosed from 2002 to 2016Multivariate Analysis of Risk Factors for Non-Variceal Hemorrhage

Conclusions: Our study of over 14,000 veterans shows that severity of liver disease at presentation, aspirin use, concurrent renal failure, alcohol abuse, prior hemorrhage, and compromised self-care by either dementia or paraplegia predict a higher risk of hemorrhage within the first year after CLD diagnosis. This study was supported by the American Society of Hematology.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/risk-factors-for-non-variceal-hemorrhage-in-patients-with-chronic-liver-disease/