Bleeding and vascular complications after percutaneous transhepatic biliary drainage: Incidence and associated factors in a Vietnamese tertiary center

Table 1 Baseline and procedural characteristics by bleeding or vascular complication status, n (%)/median (interquartile range)

Characteristic	No bleeding (n = 218)	Bleeding/vascular complication (n = 16)	Overall (n = 234)	P value
Demographics and clinical variables
Age (years)	62 (52, 69)	67 (52, 83)	63 (52, 70)	0.221
Male sex	88 (40.4)	12 (75.0)	100 (42.7)	0.009
Body mass index (kg/m2)	21.0 (18.7, 23.0)	20.0 (18.3, 22.0)	21.0 (18.7, 23.0)	0.319
Acute cholangitis (TG18)	130 (59.6)	13 (81.2)	143 (61.1)	0.113
Hypertension	49 (22.5)	5 (31.2)	54 (23.1)	0.537
Diabetes mellitus	26 (11.9)	3 (18.8)	29 (12.4)	0.428
Coronary artery disease	16 (7.3)	3 (18.8)	19 (8.1)	0.129
Chronic kidney disease	3 (1.4)	0 (0)	3 (1.3)	1.000
Cirrhosis	2 (0.9)	0 (0)	2 (0.9)	1.000
Documented antithrombotic use	5 (2.3)	2 (12.5)	7 (3.0)	0.075
Hemostasis and laboratory variables
Platelet count (× 109/L)1	305.0 (230.0, 401.5)	312.5 (180.8, 411.0)	305.0 (224.0, 403.0)	0.576
INR2	1.19 (1.06, 1.36)	1.19 (1.05, 1.31)	1.19 (1.06, 1.36)	0.974
PT (seconds)2	14.00 (12.80, 16.52)	14.25 (12.78, 17.77)	14.00 (12.80, 16.62)	0.601
Platelet < 150 × 109/L1	18 (8.5)	3 (18.8)	21 (9.3)	0.174
INR >1.52	32 (15.4)	3 (18.8)	35 (15.6)	0.721
WBC before PTBD (K/μL)	9.7 (7.5, 14.5)	15.0 (10.4, 19.3)	10.0 (7.7, 15.0)	0.010
Total bilirubin before (μmol/L)	246 (134, 350)	252 (78, 320)	248 (125, 350)	0.436
Direct bilirubin before (μmol/L)	141 (88, 200)	140 (44, 185)	141 (87, 199)	0.388
AST before (U/L)	138 (79, 201)	110 (80, 195)	136 (80, 201)	0.851
ALT before (U/L)	117 (54, 191)	103 (46, 221)	114 (54, 192)	0.704
Imaging and procedural variables
Right intrahepatic duct diameter (mm)	11.0 (8.0, 14.0)	10.0 (7.0, 11.0)	10.5 (8.0, 13.0)	0.200
Left intrahepatic duct diameter (mm)	11.0 (9.0, 14.0)	10.5 (7.5, 11.0)	11.0 (9.0, 13.0)	0.095
Target-duct diameter on punctured side (mm)	11.0 (9.0, 14.0)	10.0 (7.0, 11.0)	11.0 (8.0, 13.8)	0.131
Choledocholithiasis	20 (9.2)	7 (43.8)	27 (11.5)	< 0.001
Procedure duration (minutes)	25 (20, 35)	30 (25, 45)	25 (20, 35)	0.013
More than one needle pass	21 (9.6)	8 (50.0)	29 (12.4)	< 0.001
Right-sided drainage	150 (68.8)	12 (75.0)	162 (69.2)	0.781
Technical success	211 (96.8)	15 (93.8)	226 (96.6)	0.438
Catheter size > 8 Fr	4 (1.8)	0 (0)	4 (1.7)	1.000

¹Platelet data were available for 227 patients (211 without bleeding or vascular complications and 16 with bleeding or vascular complications).

²International normalized ratio and prothrombin time data were available for 224 patients (208 without bleeding or vascular complications and 16 with bleeding or vascular complications).

P values were derived using the Wilcoxon rank-sum test for continuous variables and Fisher’s exact test (or Pearson’s χ² test when appropriate) for categorical variables. TG18: Tokyo Guidelines 2018; PT: Prothrombin time; INR: International normalized ratio; WBC: White blood cell count; PTBD: Percutaneous transhepatic biliary drainage; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 2 Factors independently associated with bleeding or vascular complications after percutaneous transhepatic biliary drainage (reduced Firth penalized logistic regression model)

Characteristic	Adjusted OR	95%CI	P value
More than one needle pass	7.91	2.05-30.59	0.003
Choledocholithiasis	18.80	4.79-73.73	< 0.001
Procedure time (per 10 minutes)	1.44	1.05-1.96	0.023
Target-duct diameter on punctured side (per 1 mm)	0.82	0.69-0.98	0.026

Model characteristics: n = 234, bleeding or vascular events = 16, number of predictors = 4, events-per-variable = 4.0. Internal validation: Apparent area under the receiver-operating characteristic curve = 0.873; optimism-corrected area under the receiver-operating characteristic curve = 0.848; optimism-corrected calibration slope = 0.886. Sensitivity analyses are described in the results text. OR: Odds ratio; CI: Confidence interval.