S2758 Post-ERCP Outcomes in Cirrhotic Patients With Thrombocytopenia: A Propensity-Matched Retrospective Comparative Analysis

Introduction: Thrombocytopenia is a significant complication of liver cirrhosis. Patients with cirrhosis face increased risks during procedures. This study examines the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in patients with cirrhosis and low platelet counts who are treated for choledocholithiasis. We aim to assess the impact of mild (101,000–150,000 cells/µL) versus moderate (51,000–100,000 cells/µL) thrombocytopenia on post-ERCP outcomes in a matched cohort of cirrhosis patients. Methods: A retrospective cohort study from the TriNetX network included patients aged 18 and older with cirrhosis undergoing ERCP for choledocholithiasis. Cohorts were divided by platelet counts into mild and moderate thrombocytopenia, with 4,255 patients each. Propensity score matching considered 15 factors, including demographics (age, gender, race) and lab parameters (PT, aPTT, INR, hemoglobin, hematocrit) and body mass index. Univariate regression analysis assessed all-cause mortality as the primary outcome, while secondary outcomes included sepsis, severe sepsis, septic shock, AKI, post-ERCP bleeding, blood transfusion needs, ICU admission, and adverse events. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: After propensity matching, 4255 patients were analyzed for primary and secondary outcomes. All-cause mortality was significantly higher in the post-ERCP cohort with moderate thrombocytopenia [OR (95% CI): 1.48 (1.26-1.75)]. Moderate thrombocytopenia also correlated with increased adverse events, including sepsis (OR 1.31; 95% CI 1.15–1.48), acute kidney injury (OR 1.36; 95% CI 1.21–1.52), and hepatorenal syndrome (OR 1.74; 95% CI 1.22–2.47). Significant post-procedural outcomes included post-ERCP bleeding (OR 1.25; 95% CI 1.11–1.72) and the need for blood transfusion (OR 1.70; 95% CI 1.42–2.03) within the moderate thrombocytopenia cohort. Other outcomes like ICU admission, jaundice, bile duct perforation, post-ERCP pancreatitis, and abdominal pain showed no significant differences. Conclusion: Patients with cirrhosis and moderate thrombocytopenia undergoing ERCP for choledocholithiasis experience significantly worse outcomes than those with mild thrombocytopenia, including higher mortality rates, increased blood transfusion requirements, and greater complications such as sepsis and AKI. These findings highlight the necessity of thorough pre-procedural planning and vigilant monitoring in this high-risk population.