慢性肝病 (CLD) 患者的非静脉曲张出血会增加发病率、死亡率和医疗费用。关于 CLD 人群非静脉曲张出血危险因素的数据有限。本研究的目的是评估各种临床和实验室参数对 CLD 患者非静脉曲张出血的预测价值。我们对退伍军人健康管理局数据库中 2002 年至 2018 年诊断为 CLD 的美国退伍军人进行了一项回顾性队列研究。我们从现有的出血风险预测模型、肝病严重程度的风险计算器、预后合并症的查尔森指数和先前的文献中得出了候选变量。我们使用竞争风险分析来研究 CLD 患者的假定危险因素与非静脉曲张出血发生率之间的关系。在 15,183 名没有癌症或抗凝使用史的 CLD 患者中，674 名在 CLD 1 年内经历了非静脉曲张出血诊断。在多变量分析中，26 个候选变量中的 11 个独立预测非静脉曲张出血：种族、国际标准化比值 (INR) > 1.5、胆红素 ≥ 2 mg/dL、白蛋白 ≤ 3.5 g/dL、贫血、酗酒、抗血小板治疗、慢性肾病、痴呆、质子泵抑制剂处方和近期感染。在这项对近 15,000 名退伍军人进行的研究中，诊断 CLD 后第一年内非静脉曲张出血的危险因素包括非白种人种、表明严重肝病的实验室参数除了在一般非 CLD 人群中观察到的出血危险因素外，近期感染也同样如此。版权所有 2024，Afzal 等人。

Non-variceal hemorrhage in patients with chronic liver disease (CLD) increases morbidity, mortality, and healthcare costs. There are limited data on risk factors for non-variceal hemorrhage in the CLD population. The aim of this study was to assess the predictive value of various clinical and laboratory parameters for non-variceal hemorrhage in CLD patients.We conducted a retrospective cohort study of US veterans diagnosed with CLD between 2002 and 2018 within the Veterans Health Administration database. We derived candidate variables from existing risk prediction models for hemorrhage, risk calculators for severity of liver disease, Charlson index of prognostic comorbidities, and prior literature. We used a competing risk analysis to study the relationship between putative risk factors and incidence of non-variceal hemorrhage in patients with CLD.Of 15,183 CLD patients with no history of cancer or anticoagulation use, 674 experienced non-variceal hemorrhage within 1 year of CLD diagnosis. In multivariable analysis, 11 of the 26 candidate variables independently predicted non-variceal hemorrhage: race, international normalized ratio (INR) > 1.5, bilirubin ≥ 2 mg/dL, albumin ≤ 3.5 g/dL, anemia, alcohol abuse, antiplatelet therapy, chronic kidney disease, dementia, proton pump inhibitor prescription, and recent infection.In this study of almost 15,000 veterans, risk factors for non-variceal bleeding within the first year after diagnosis of CLD included non-Caucasian race, laboratory parameters indicating severe liver disease and recent infection in addition to the risk factors for bleeding observed in a general non-CLD population.Copyright 2024, Afzal et al.