ArticleBMC gastroenterology2026
Risk of intracranial hemorrhage in critically ill ACLF patients: a retrospective single center cohort study.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCritically 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.
methodsOne 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.
resultsCerebral 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).
conclusionsAlthough 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.
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