Bleeding complications predict, but don’t cause poor outcomes in patients with acute liver failure

WASHINGTON — Patients with acute liver failure and bleeding complications tend to have worse outcomes than those with acute liver failure and no bleeding complications, but the complications do not appear to be the cause of the worse prognosis, a presenter said here.

“Non-procedure-related bleeding complications were seen in about 10% of patients … and they actually had worse outcome, but the poor outcome occurred after 7 days when the bleeding occurred within the first 7 days,” Todd Stravitz, MD, of Virginia Commonwealth University said at The Liver Meeting. “The implication here is that bleeding is really a marker for systemic complications of acute liver failure and is probably not actually responsible for the deaths of those patients.”

Todd Stravitz

Researchers examined records of 1,598 patients in the ALF Study Group, of whom 752 (47%) spontaneously survived, 390 (24%) underwent liver transplant, and 517 (32%) died – 61 after transplant. Patients who also had systemic inflammatory response syndrome (SIRS) at the time of admission were more likely to have bleeding complications (13.4% to 7.1%, P<.001).

The study found that while platelet count was significantly lower in patients with bleeding complications on all 7 days after admission (P<.001 for each day), the international normalized ratio was similar between the two groups. Furthermore, only 18% of patients who received red blood cell transfusions had bleeding complications, and only 65% of patients who had bleeding complications received red blood cell transfusions.

And the incidence of bleeding complications and transfusion of red blood cells, plasma and platelets were all significantly higher in patients with poor outcome (liver transplant or death) than they were among spontaneous survivors (all P<.001), he said.

“Clinicians are overly concerned about bleeding complications in patients with acute liver failure,” Stravitz said. “Bleeding complications occur and they connote a poor prognosis, but it’s not because of the bleeding itself, it’s because of all the other things associated with the bleeding, and that’s what causes the poor prognosis.”

Disclosure: Stravitz reports no relevant financial disclosures.

For more information:

Stravitz R. #281: Spontaneous Bleeding Complications in Acute Liver Failure Presented at: The Liver Meeting 2013; Nov. 1-5, Washington.