Diagnostic yield and adverse events of liver biopsy in intensive-care-unit patients: a multicenter retrospective observational cohort study

Background To investigate the adverse events, diagnostic yield, and therapeutic implications of liver biopsy in intensive-care-unit (ICU) patients. Methods Retrospective observational multicenter cohort study. Consecutive adults admitted to any of the four participating ICUs in France between January 1, 2006 and March 1, 2023, and who had a liver biopsy during the ICU stay were included. Results We included 139 patients (median age, 52 years; 69% male) biopsied via the transjugular ( n = 97), percutaneous ( n = 30), or laparoscopic ( n = 1) route (missing data n = 11). The liver parenchyma was evaluable in 137/139 (99%) patients, who had 187 histological diagnoses in total. The pathological diagnoses matched the pre-biopsy diagnostic hypotheses in 83 (60%) patients. The most common were chronic or acute-on-chronic liver disease ( n = 78, 56%), malignancy ( n = 27, 19%), and infectious disease ( n = 12, 9%). Among other diagnoses ( n = 17, 12%), drug toxicity and biliary diseases predominated. The liver biopsy had therapeutic implications for 80 (58%) patients, among whom 66 (82%) received a new treatment, 7 (9%) were continued on empirically initiated treatment, and 7 (9%) were taken off the previous treatment. WHO grade 3–4 bleeding developed in 10 (7%) patients and was fatal in 2 patients. Higher severity scores, higher urea level, and absence of cirrhosis were associated with a greater risk of bleeding complications. Day-90 survival was not significantly different between the groups with vs. without therapeutic implications of the biopsy. Conclusions In ICU patients, liver biopsy provides a wide range of diagnoses and guides treatment decisions. However, the risk of potentially fatal bleeding is a major concern. We identified risk factors for bleeding.