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Mo1900 Correction of Coagulopathy in Non-Bleeding Cirrhotic Patients Undergoing Minor Invasive Procedures: A Systematic Review
0.006), along with creatinine^0.74 mg/dL (OR 19.67, 95%CI 2.78-416.59, P=0.002) that was defined as optimal cutoff in Child-Pugh C patients. Conclusions: In Child-Pugh C patients, CRP^0.53 mg/dL is associated with early mortality after variceal bleeding in patients with liver cirrhosis and may become a predictive marker of mortality. Mo1900
AASLD Abstracts
Correction of Coagulopathy in Non-Bleeding Cirrhotic Patients Undergoing Minor Invasive Procedures: A Systematic Review Matthew J. McConnell, Elias Spyrou, Tarek Sawas, Saleh Alqahtani, Ruben Hernaez Purpose: Liberal use of blood products to correct coagulopathy prior to invasive procedures in patients with cirrhosis is a common practice, but evidence increasingly supports a restrictive transfusion strategy for blood products in a variety of clinical scenarios, prompting this systematic review. Methods: Using a pre-established search engine, three reviewers independently evaluated and retrieved papers in EMBASE, PUBMED and reference lists, with no date or language restriction until April 2014. Only reports with cirrhotic patients undergoing elective minor procedures including data on bleeding complications were included. Papers on major surgeries were excluded. Results: 6,366 abstracts were reviewed, of which 6 met the inclusion criteria. One randmoized controlled trial (RCT) examined dental procedures and found bleeding in 3-6% of patients (both in groups receiving and not receiving blood products). Two studies (both case control studies) evaluated paracentesis. One found no clear benefit of prophylactic fresh frozen plasma (FFP), and the other had a very low incidence of bleeding (0.19%) with 8/9 patients who bled receiving no correction of coagulopathy and one 1/9 patients receiving prophylactic 1-desamino-8-D-arginine vasopressin (DDAVP). A case control study examining multiple common minor procedures found no clear difference in complications between similar groups undergoing a variety of common procedures with or without prophylactic FFP or platelets (Plt). Finally, a RCT using eltrombopag vs. placebo in cirrhotics with platelets <50K followed by a supplemental platelet transfusion if needed prior to invasive procedures found bleeding complications in 17% of the eltrombopag group vs. 23% of the placebo group (95% confidence interval, -15 to 3). Conclusion: There are a very limited number of studies examining the utility of prophylactic correction of coagulopathy in stable cirrhotic patients undergoing minor invasive procedures. Overall there is a high risk of bias in the evidence, but no study shows a clear benefit to prophylactic transfusion. Given the potential complications of the over-transfusion of blood products, further RCTs or high-quality prospective observational studies are needed to determine the best transfusion strategy in cirrhotic patients undergoing invasive procedures. Review of the literature on correction of coagulopathy in non-bleeding cirrhotic patients and effect on bleeding complications (last updated April 2014)
Sensitivity of platelet count/spleen diameter ratio (PSR) in predicting esophageal varices (EV) increases as the proportion of patients with Child-Pugh class B & C (PCPBC) increases in the study cohort; circles representing the studies and circles' size correlate with studies' weight in the analysis.
Accuracy of platelet count/spleen diameter ratio (PSR) in predicting esophageal varices increases as the proportion of patients with Child-Puch class B & C (PCPBC) increases in the study cohort; circles representing the studies and circles' size correlate with studies' weight in the analysis. Mo1899 C-Reactive Protein Predicts Early Mortality After Acute Esophageal Variceal Bleeding in Patients With Cirrhosis Takeshi Ichikawa, Hiroshi Sasaki, Yoshiyuki Tawa Background and Aims: Besides infections, C-reactive protein (CRP) levels may be elevated in patients with cancer or systemic inflammation. Although synthesized by the liver, elevated CRP levels can be observed in the event of advanced liver failure. The aim of this study was to investigate the prognostic value of CRP after acute variceal bleeding in cirrhotic patients. Methods: We evaluated 144 consecutive cirrhotic patients (Child-Pugh A and B: C = 80: 64) admitted with esophageal variceal bleeding between January 2009 and May 2014. 6-week mortality assessments according to risk factors were performed. We assessed the optimal CRP cutoff by receiver operating characteristic (ROC) curve and tested its impact on 6-week mortality by univariate analysis and multivariate logistic regression analysis. We next investigated the 6-week mortality of patients with elevated CRP associated with infection and patients with elevated CRP non-associated with infection. Results: The overall 6-week mortality rate was 22.3%. Endoscopic band ligation was feasible in 91.8% of patients. ChildPugh C patients showed a significant high mortality compared to Child-Pugh A or B patients (41.0% vs. 6.3%, P<0.0001). We defined a CRP level<0.53/^0.53 mg/dL as optimal cutoff for further 6-week mortality assessments in Child-Pugh C patients. In Child-Pugh C patients, CRP^0.53 mg/dL (elevated CRP) at admission was associated with 6-week mortality univariately (elevated CRP vs. CRP<0.53 mg/dL (normal CRP), 69.0% vs. 15.6%; P<0.0001). In Child-Pugh A and B patients, elevated CRP was not associated with higher 6-week mortality (elevated CRP vs. normal CRP, 12.0% vs. 3.7%, P=0.159). Elevated CRP non-associated with infection in Child-Pugh C patients was also associated with an increase in 6-week mortality (elevated CRP non-associated with infection vs. normal CRP, 63.6% vs. 18.2%, P=0.006). Child-Pugh C patients with elevated CRP associated with infection did not show significantly higher 6-week mortality, compared to those with non-associated with infection (70.6% vs. 63.6%, P=0.7005). By multivariate analysis, we determined that elevated CRP was the independent predictor for 6-week mortality (OR 10.37, 95%CI 1.86-92.00, P=
AASLD Abstracts
* Defined as 1. shock, low blood pressure or irritation of peritoneum; 2. Hemoglobin < 10 g/L; 3. hemorrhage near liver or peritoneal cavity visualized on ultrasound ***Other patients underwent major procedures Mo1901 Evaluation of Portal Hypertension and Cirrhosis in Patients With Hepatic Sarcoidosis: A Prospective Single Center Study Binu John, Sajan Jiv Singh Nagpal, Thomas Plesec, Ramprasad Jegadeesan, Rocio Lopez, Naim Alkhouri, kristin B. Highland, daniel culver Background and Aims: Sarcoidosis of the liver is a cause of portal hypertension both in the presence of cirrhosis as well as its absence (pre-sinusoidal portal hypertension). Unfortunately, it is a poorly studied condition and the clinical, histological or laboratory parameters that predict progression to cirrhosis are unknown. The presence of portal hypertension may be an important factor that predicts outcomes in patients with hepatic Sarcoidosis. There are no prospective studies evaluating portal pressures in hepatic Sarcoidosis and its correlation with histology and non-invasive markers of fibrosis. Methods: We prospectively evaluated 21 consecutive patients with hepatic sarcoidosis seen at the Cleveland clinic center
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AASLD Abstracts
Correction of Coagulopathy in Non-Bleeding Cirrhotic Patients Undergoing Minor Invasive Procedures: A Systematic Review Matthew J. McConnell, Elias Spyrou, Tarek Sawas, Saleh Alqahtani, Ruben Hernaez Purpose: Liberal use of blood products to correct coagulopathy prior to invasive procedures in patients with cirrhosis is a common practice, but evidence increasingly supports a restrictive transfusion strategy for blood products in a variety of clinical scenarios, prompting this systematic review. Methods: Using a pre-established search engine, three reviewers independently evaluated and retrieved papers in EMBASE, PUBMED and reference lists, with no date or language restriction until April 2014. Only reports with cirrhotic patients undergoing elective minor procedures including data on bleeding complications were included. Papers on major surgeries were excluded. Results: 6,366 abstracts were reviewed, of which 6 met the inclusion criteria. One randmoized controlled trial (RCT) examined dental procedures and found bleeding in 3-6% of patients (both in groups receiving and not receiving blood products). Two studies (both case control studies) evaluated paracentesis. One found no clear benefit of prophylactic fresh frozen plasma (FFP), and the other had a very low incidence of bleeding (0.19%) with 8/9 patients who bled receiving no correction of coagulopathy and one 1/9 patients receiving prophylactic 1-desamino-8-D-arginine vasopressin (DDAVP). A case control study examining multiple common minor procedures found no clear difference in complications between similar groups undergoing a variety of common procedures with or without prophylactic FFP or platelets (Plt). Finally, a RCT using eltrombopag vs. placebo in cirrhotics with platelets <50K followed by a supplemental platelet transfusion if needed prior to invasive procedures found bleeding complications in 17% of the eltrombopag group vs. 23% of the placebo group (95% confidence interval, -15 to 3). Conclusion: There are a very limited number of studies examining the utility of prophylactic correction of coagulopathy in stable cirrhotic patients undergoing minor invasive procedures. Overall there is a high risk of bias in the evidence, but no study shows a clear benefit to prophylactic transfusion. Given the potential complications of the over-transfusion of blood products, further RCTs or high-quality prospective observational studies are needed to determine the best transfusion strategy in cirrhotic patients undergoing invasive procedures. Review of the literature on correction of coagulopathy in non-bleeding cirrhotic patients and effect on bleeding complications (last updated April 2014)
Sensitivity of platelet count/spleen diameter ratio (PSR) in predicting esophageal varices (EV) increases as the proportion of patients with Child-Pugh class B & C (PCPBC) increases in the study cohort; circles representing the studies and circles' size correlate with studies' weight in the analysis.
Accuracy of platelet count/spleen diameter ratio (PSR) in predicting esophageal varices increases as the proportion of patients with Child-Puch class B & C (PCPBC) increases in the study cohort; circles representing the studies and circles' size correlate with studies' weight in the analysis. Mo1899 C-Reactive Protein Predicts Early Mortality After Acute Esophageal Variceal Bleeding in Patients With Cirrhosis Takeshi Ichikawa, Hiroshi Sasaki, Yoshiyuki Tawa Background and Aims: Besides infections, C-reactive protein (CRP) levels may be elevated in patients with cancer or systemic inflammation. Although synthesized by the liver, elevated CRP levels can be observed in the event of advanced liver failure. The aim of this study was to investigate the prognostic value of CRP after acute variceal bleeding in cirrhotic patients. Methods: We evaluated 144 consecutive cirrhotic patients (Child-Pugh A and B: C = 80: 64) admitted with esophageal variceal bleeding between January 2009 and May 2014. 6-week mortality assessments according to risk factors were performed. We assessed the optimal CRP cutoff by receiver operating characteristic (ROC) curve and tested its impact on 6-week mortality by univariate analysis and multivariate logistic regression analysis. We next investigated the 6-week mortality of patients with elevated CRP associated with infection and patients with elevated CRP non-associated with infection. Results: The overall 6-week mortality rate was 22.3%. Endoscopic band ligation was feasible in 91.8% of patients. ChildPugh C patients showed a significant high mortality compared to Child-Pugh A or B patients (41.0% vs. 6.3%, P<0.0001). We defined a CRP level<0.53/^0.53 mg/dL as optimal cutoff for further 6-week mortality assessments in Child-Pugh C patients. In Child-Pugh C patients, CRP^0.53 mg/dL (elevated CRP) at admission was associated with 6-week mortality univariately (elevated CRP vs. CRP<0.53 mg/dL (normal CRP), 69.0% vs. 15.6%; P<0.0001). In Child-Pugh A and B patients, elevated CRP was not associated with higher 6-week mortality (elevated CRP vs. normal CRP, 12.0% vs. 3.7%, P=0.159). Elevated CRP non-associated with infection in Child-Pugh C patients was also associated with an increase in 6-week mortality (elevated CRP non-associated with infection vs. normal CRP, 63.6% vs. 18.2%, P=0.006). Child-Pugh C patients with elevated CRP associated with infection did not show significantly higher 6-week mortality, compared to those with non-associated with infection (70.6% vs. 63.6%, P=0.7005). By multivariate analysis, we determined that elevated CRP was the independent predictor for 6-week mortality (OR 10.37, 95%CI 1.86-92.00, P=
AASLD Abstracts
* Defined as 1. shock, low blood pressure or irritation of peritoneum; 2. Hemoglobin < 10 g/L; 3. hemorrhage near liver or peritoneal cavity visualized on ultrasound ***Other patients underwent major procedures Mo1901 Evaluation of Portal Hypertension and Cirrhosis in Patients With Hepatic Sarcoidosis: A Prospective Single Center Study Binu John, Sajan Jiv Singh Nagpal, Thomas Plesec, Ramprasad Jegadeesan, Rocio Lopez, Naim Alkhouri, kristin B. Highland, daniel culver Background and Aims: Sarcoidosis of the liver is a cause of portal hypertension both in the presence of cirrhosis as well as its absence (pre-sinusoidal portal hypertension). Unfortunately, it is a poorly studied condition and the clinical, histological or laboratory parameters that predict progression to cirrhosis are unknown. The presence of portal hypertension may be an important factor that predicts outcomes in patients with hepatic Sarcoidosis. There are no prospective studies evaluating portal pressures in hepatic Sarcoidosis and its correlation with histology and non-invasive markers of fibrosis. Methods: We prospectively evaluated 21 consecutive patients with hepatic sarcoidosis seen at the Cleveland clinic center
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