Acute kidney injury, but not sepsis, is associated with higher procedure‐related bleeding in patients with decompensated cirrhosis

Background Bleeding after low‐risk invasive procedures can be life‐threatening or can lead to further complications in decompensated cirrhosis patients. In unstratified cohorts of hospitalized patients with cirrhosis, the rate of procedure‐related bleeding is low despite abnormal coagulation parameters. Our objective was to identify patients with decompensated cirrhosis at a high risk of developing procedure‐related bleeding in whom the value of pre‐procedure transfusions could be assessed. Methods Hospitalized patients with cirrhosis who developed post‐paracentesis 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‐paracentesis 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. Results On multivariate analysis, acute kidney injury prior to paracentesis was the only independent predictor of post‐paracentesis hemoperitoneum (OR 4.3, 95% CI 1.3‐13.5, P = .01), independent of MELD score, large volume paracentesis, sepsis, platelets, INR and haemoglobin levels. Conclusions 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‐procedure bleeding in patients with decompensated cirrhosis. Although end‐stage renal disease is a known cause of bleeding in non‐cirrhotic patients, there are no studies establishing acute kidney injury as a risk factor for post‐procedure bleeding in cirrhosis. Future studies investigating blood product transfusion needs in cirrhosis prior to procedures should carefully look at patients with acute kidney injury.