{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:35:07Z","timestamp":1791412507850,"version":"4.3.3"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,2,24]],"date-time":"2018-02-24T00:00:00Z","timestamp":1519430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009680","name":"Yale Liver Center","doi-asserted-by":"publisher","award":["P30 DK34989"],"award-info":[{"award-number":["P30 DK34989"]}],"id":[{"id":"10.13039\/100009680","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Bleeding after low\u2010risk invasive procedures can be life\u2010threatening or can lead to further complications in decompensated cirrhosis patients. In unstratified cohorts of hospitalized patients with cirrhosis, the rate of procedure\u2010related bleeding is low despite abnormal coagulation parameters. Our objective was to identify patients with decompensated cirrhosis at a high risk of developing procedure\u2010related bleeding in whom the value of pre\u2010procedure transfusions could be assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Hospitalized patients with cirrhosis who developed post\u2010paracentesis hemoperitoneum confirmed by CT scan, from the period of January 2012 to August 2016, constituted the study group. They were compared to patients hospitalized in the same period in whom post\u2010paracentesis hemoperitoneum was suspected but ruled out by CT scan. A retrospective chart review was conducted to determine specifics of the adverse event, patient characteristics and risk factors for bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>On multivariate analysis, acute kidney injury prior to paracentesis was the only independent predictor of post\u2010paracentesis hemoperitoneum (OR 4.3, 95% CI 1.3\u201013.5, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), independent of MELD score, large volume paracentesis, sepsis, platelets, INR and haemoglobin levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Infection\/sepsis is generally considered predictive of bleeding in cirrhosis. Our study suggests that acute kidney injury, and not sepsis, is the most important predictor of post\u2010procedure bleeding in patients with decompensated cirrhosis. Although end\u2010stage renal disease is a known cause of bleeding in non\u2010cirrhotic patients, there are no studies establishing acute kidney injury as a risk factor for post\u2010procedure bleeding in cirrhosis. Future studies investigating blood product transfusion needs in cirrhosis prior to procedures should carefully look at patients with acute kidney injury.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13712","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T10:32:37Z","timestamp":1517567557000},"page":"1437-1441","source":"Crossref","is-referenced-by-count":68,"title":["Acute kidney injury, but not sepsis, is associated with higher procedure\u2010related bleeding in patients with decompensated cirrhosis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3414-1701","authenticated-orcid":false,"given":"Adelina","family":"Hung","sequence":"first","affiliation":[{"name":"Digestive Diseases Section Department of Medicine Yale University  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Garcia\u2010Tsao","sequence":"additional","affiliation":[{"name":"Digestive Diseases Section Department of Medicine Yale University  New Haven CT USA"},{"name":"Digestive Diseases Section Department of Internal medicine VA\u2010CT Healthcare System  West Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.239.7.628"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-199806000-00020"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(97)70210-5"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.0856b.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2012.02.012"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1011170"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21303"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.498"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2005.02387.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28148"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.12.029"},{"key":"e_1_2_9_13_1","first-page":"1064","article-title":"Coagulation in liver disease: a guide for the clinician","volume":"11","author":"Northup PG","year":"2013","journal-title":"Hepatology"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1182\/blood.V94.8.2569.420k13_2569_2574","article-title":"Uremic bleeding: closing the circle after 30\u00a0years of controversies?","volume":"94","author":"Noris M","year":"1999","journal-title":"Blood"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1182\/asheducation.V2012.1.168.3798232","article-title":"Hemostatic defects in liver and renal dysfunction","volume":"2012","author":"Mannucci PM","year":"2012","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-835678"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH10-12-0785"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(02)00208-8"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.14218\/JCTH.2015.00015"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.13712","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.13712","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T16:26:51Z","timestamp":1694276811000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.13712"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,24]]},"references-count":18,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2018,8]]}},"alternative-id":["10.1111\/liv.13712"],"URL":"https:\/\/doi.org\/10.1111\/liv.13712","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,24]]}}}