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Observational Study
. 2015 Dec;94(49):e2225.
doi: 10.1097/MD.0000000000002225.

Hemorrhagic Complications Following Abdominal Paracentesis in Acute on Chronic Liver Failure: A Propensity Score Analysis

Su Lin  1 , Mingfang Wang, Yueyong Zhu, Jing Dong, Zhiyuan Weng, Lingyun Shao, Jing Chen, Jiaji Jiang
Affiliations
Observational Study

Hemorrhagic Complications Following Abdominal Paracentesis in Acute on Chronic Liver Failure: A Propensity Score Analysis

Su Lin et al. Medicine (Baltimore). 2015 Dec.

Abstract

Patients with acute on chronic liver failure (ACLF) usually present with severe coagulopathy. Abdominal paracentesis is often performed in these patients. The aim of this study was to analyze the prevalence of hemorrhagic events after paracentesis and the predictive factors of this condition in ACLF populations.ACLF patients who underwent paracentesis were retrospectively enrolled within a 5-year period. A propensity score (PS) matching analysis was used to select matched cases from the overall nonhemorrhagic group to be used as the control group. Hemorrhagic complications and risk factors were examined using logistic regression analysis.A total of 602 abdominal paracenteses were carried out on 218 ACLF patients and 18 (2.99%) hemorrhagic complications were identified. The MELD scores were higher in hemorrhagic patients than overall patients before PS matching (25.77±6.65 vs 21.04 ± 7.93, P = 0.013). We matched 18 cases with bleeding events to 72 unique cases without. The hemorrhagic group had significantly lower fibrinogen levels and higher PT levels than nonhemorrhagic cases. Logistic regression analysis revealed that lower fibrinogen levels could independently predict hemorrhagic complications (OR: 0.128, 95% CI: 0.023-0.697, P = 0.017). The best cut-off value for reliable measurement of fibrinogen levels was 0.70 g/L, with a sensitivity of 76.4% and a specificity of 80.0%. The area under curve was 0.733 (95% CI 0.604-0.862, P value 0.002).Severe hemorrhagic complications occur more commonly in ALCF patients than previously thought. A low fibrinogen level is an independent predictor of bleeding events in patients with MELD >25.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study design.
FIGURE 2
FIGURE 2
Kaplan–Meier analysis of the risk of hemorrhagic complications according to the fibrinogen levels.
FIGURE 3
FIGURE 3
ROC curve of the fibrinogen levels for predicting hemorrhagic complications.
See this image and copyright information in PMC

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