Quick, Safe, Effective: Ultrasound-Guided Percutaneous Liver Biopsy in the Pediatric Patient

BACKGROUND

Percutaneous liver biopsy has proven to be a valuable tool in the workup of pediatric acute liver failure and the management of post-transplant rejection. However, consensus regarding pre-procedure laboratory values and post-procedure monitoring is lacking.

OBJECTIVE

To characterize the incidence of complications, procedural time, and specimen adequacy for percutaneous liver biopsy in the pediatric patient.

METHODS

Retrospective review of percutaneous liver biopsies at a single institution was performed for a 5-year span. Procedural notes and anesthesia records were sampled for patient weight and procedural factors across a continuous 6-month period, as well as for the subgroup of patients under 24 months of age. A representative continuous subset of pathology reports comprising 376 patients were reviewed for estimation of specimen adequacy.

RESULTS

Eight hundred and sixty-seven ultrasound-guided percutaneous liver biopsies were performed in a 5-year period, 450 of which were in the post-transplant setting with about a 3:1 ratio of split: whole liver transplant. Patient ages ranged from 1 month to 21 years old, with weight ranging from 2.7 to 125 kg. Of the 376 pathology reports available, none were found to be inadequate for evaluation. Two major complications occurred, both of which were biliary leaks in the setting split-liver transplant. There were no incidences of post-procedure hemorrhage. Of the sample reviewed, mean "skin-to-skin" procedure time was under 8.5 min (median of 7 min). Solely among transplant patients, biopsies for split livers averaged 9.2 min, biopsies for whole livers averaged 6.2 min (two-tailed independent t test, p = 0.0426).

CONCLUSION

Ultrasound guided percutaneous liver biopsy is fast, useful, and safe in pediatric patients on an outpatient basis with same day discharge.

LEVEL OF EVIDENCE IV

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Association of Blood Glucose and Clinical Outcome after Mechanical Thrombectomy for Acute Ischemic Stroke

BACKGROUND

Elevated blood glucose levels following acute ischemic stroke have been associated with adverse clinical outcomes in thrombolytic and nonthrombolytic treated patients. The current study examined multiple blood glucose parameters and their association with modified Rankin Scale (mRS) score at 3 months following mechanical thrombectomy and hospital discharge.

METHODS

Acute ischemic stroke patients undergoing mechanical thrombectomy with a retrievable stent at two stroke centers were studied. Admission blood glucose level, maximum blood glucose during the hospital stay, and serial blood glucose measurements within the first 24 h of hospital admission were recorded. Variability in blood glucose level was represented by the standard deviation of the serial measurements within the first 24 h. The following demographic and clinical data was also collected: age, sex, baseline NIHSS score, onset-to-reperfusion times, hemoglobin A1c, and stroke mechanism.

RESULTS

79 patients were identified; at 3 months, 35 patients had an mRS score of 0-2 and 44 had had an mRS of 3-6. Among the blood glucose variables, standard deviation of blood glucose in the first 24 h following admission and maximum blood glucose during hospital stay were significantly higher in the mRS 3-6 group. In multivariate logistic regression analysis, only the standard deviation of blood glucose remained significant (OR = 1.07, 95% CI = 1.02-1.11, p = 0.003) in a model that adjusted for admission NIHSS score (p = 0.016) and number of stent retriever passes (p = 0.042).

CONCLUSIONS

Greater blood glucose variability following acute ischemic stroke is associated with worse clinical outcome in patients undergoing mechanical thrombectomy.