Post-ERCP Outcomes in Cirrhotic Patients With Thrombocytopenia: A Propensity-Matched Retrospective Comparative Analysis on TriNetX Health Research Database.

Background: Patients with cirrhosis have an increased risk of developing complications secondary to thrombocytopenia. This study aims to investigate post-ERCP outcomes in patients with liver cirrhosis and concomitant low platelet count who undergo endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in a large, matched cohort with cirrhosis. Methods: A retrospective cohort study was conducted using data from the TriNetX research network. Patients aged 18 years or older with cirrhosis undergoing ERCP for choledocholithiasis were included. Cohorts were categorized by platelet count into mild or moderate thrombocytopenia groups, with 5097 patients in each cohort after propensity score matching, yielding a total of 10 194 patients. Univariate regression analysis was used to assess the primary outcome, namely, all-cause mortality. Secondary outcomes included post-ERCP bleeding, post-ERCP pancreatitis, need for blood transfusion, and other adverse events such as sepsis and acute kidney injury (AKI). Odds ratios (ORs) and 95% confidence intervals (CIs) were then calculated. Results: All-cause mortality [OR 1.54 (95% CI): (1.32-1.80)] and need for blood transfusion (OR 1.37; 95% CI 1.17-1.61) were higher among patients with moderate thrombocytopenia. However, adverse events, including post-ERCP bleeding (OR 0.96; 95% CI 0.72-1.3), post-ERCP pancreatitis (OR 0.81; 95% CI 0.69-1.02), sepsis (OR 1.04; 95% CI 0.93-1.16), and AKI (OR 1.11; 95% CI 1.00-1.23), were statistically not significant between the two groups. Conclusion: The cirrhotic population with moderate thrombocytopenia undergoing ERCP for choledocholithiasis experiences significantly worse outcomes compared to those with mild thrombocytopenia.