- Email: [email protected]
Su1507 Combined Noninvasive Evaluation of Liver and Spleen Stiffness By Acoustic Radiation Force Impulse (ARFI) for Assessment of Chronic Liver Disease and Portal Hypertension
Su1504
AASLD Abstracts
Liver Cirrhosis Does Not Impair the Short-Term Outcome in Peptic Ulcer Bleeding Johanna M. Petersen, Aleksander Krag, Ove B. Schaffalitzky de Muckadell, Stig B. Laursen Objective: Variceal bleeding in patients with liver cirrhosis is associated with a considerable mortality around 10-20%. The outcome of peptic ulcer bleeding (PUB) in patients with liver cirrhosis compared to patients without cirrhosis has not been studied in detail. Method: Data were prospectively collected from consecutive patients admitted with PUB at our department through an 11-year period. We compared patient characteristics, bleeding episode, and outcome between patients with liver cirrhosis and patients without cirrhosis. Results: A total of 1002 patients were admitted with PUB during the period of inclusion. Thirty-five (3.5%) patients had cirrhosis. Compared to patients without liver cirrhosis patients with cirrhosis were younger (mean age: 58 vs 73 years; p < .001), were more often males (74% vs 54%; p=.02), more frequently had hemodynamic shock at time of admission to hospital (46% vs 29%; p=.039), a higher ASA-score (p=.005), high intake of alcohol (79% vs 12%; p<.0001), high frequency of daily smokers (78% vs 32%), and a longer duration of admission to hospital (mean: 7.5 vs 5.6 days; p=.018). However, patients with cirrhosis was only rarely diagnosed with cardiac disease (5.7% vs 42%; p<.0001) and only few had intake of aspirin (14% vs 50%; p=.001). There were no differences in B-hemoglobin (5.1 vs 5.4mmol/L), duodenal ulcer location (71% vs 57%), high-risk stigmata of bleeding (37% vs 39%), rate of rebleeding (20% vs 16%), or in-hospital mortality (8.6% vs 5.3%). Conclusions: Patients with PUB and cirrhosis are younger and only rarely diagnosed with cardiac comorbidity compared with PUB-patients without cirrhosis. Nevertheless, patients with cirrhosis and PUB have a high level of non-cardiac comorbidity and negative lifestyle factors that may explain the lack of difference in short-term mortality. Beside a difference in rate of hemodynamic shock, that may be explained by impaired cardiac response in cirrhotics, the character and severity of PUB seem similar in both groups of patients.
Multivariate analysis of factors predicting hospitalization
Su1507 Combined Noninvasive Evaluation of Liver and Spleen Stiffness By Acoustic Radiation Force Impulse (ARFI) for Assessment of Chronic Liver Disease and Portal Hypertension Suchita Jain, Ajay K. Jain, Amit K. Bundiwal, Shohini Sircar, Sandip G. Vare, Sandeep H. Kaulavkar, Mayank Jain, Rahul S. Agrawal, Suresh A. Hirani
Su1505 Shear Wave Elastography for the Assessment of Portal Hypertension Before and After Transjugular Intrahepatic Portosystemic Shunt Implantation, a Pilot Study Bo Wei, Chengwei Tang Objective: The objective of this study was to investigate the correlation between hepatic venous pressure gradient (HVPG) and liver stiffness measurement (LSM) before and after transjugular intrahepatic portosystemic shunt (TIPS) implantation. Materials and Methods: twelve patients with decompensated cirrhosis were examined twice by shear wave elastography (SWE)as well as prior and subsequent TIPS intervention; HVPG was also measured during TIPS placement. Results: All patients had decompensated cirrhosis yielding high LS , a decrease of LS after TIPS placement was observed (liver: 20.15 +/- 2.67kPa vs 17.06 +/1.87 kPa, P = 0.01). The changes were correlated with the relative change of HVPG (R2 = 0.419, P = 0.018). Conclusions: The observed linear correlation between LSM and HVPG raises the prospect of a reliable noninvasive assessment of portal pressure by shear wave elastography in the follow-up of TIPS placements.
Su1506 Predictors of Hospitalization After Elective Endoscopic Variceal Ligation in Cirrhosis V Sumana Kumarappa, Nigel Girgrah, Shobha Joshi, Natalie Bzowej, Gia Tyson, George Therapondos Introduction Endoscopic variceal ligation (EVL) is the treatment of choice for esophageal varices in cirrhosis and reportedly carries a 3-6% risk of bacteremia. Although antibiotics are strongly recommended in patients with active variceal bleeding, it is not known whether mortality, morbidity and hospitalization rates after elective EVL may be improved using a similar approach. Aims To record 2 week outcomes after elective EVL (both primary and secondary prophylaxis) in patients with cirrhosis. To identify predictors of hospitalization after this elective procedure. Methods This is a retrospective study (n =200) of all consecutive patients with cirrhosis who had elective EVL from Jan 2014 to Aug 2015 at a tertiary Liver Center. Detailed information regarding mortality, hospitalization and other critical events was recorded from the electronic health record for the 2 weeks after elective EVL. Results Baseline charactersitics of study group : Table 1 Hospitalizations: While there were no deaths, 17 patients were hospitalized (8.5%). Rate of hospitalization in patients with and without ascites was 11.9% (15/126) and 2.7% (2/74) respectively (p = 0.03). Most of the admissions (15/17) were observed in patients with ascites. In the ascites patients, 2/17(11.7%) on antibiotics (ABX) for prophylaxis of spontaneous bacterial peritonitis (SBP) were hospitalized vs 13/109(11.9%) not on ABX for SBP prohylaxis (p =NS). Causes of hospitalizations: Gastrointestinal bleed (5/17), worsening ascites (6/17), fever (1/17), cellulitis(1/17), TACE(1/ 17), liver transplant (2/17) Predictors of hospitalization: Table 2 A multivariate analysis to predict risk factors for hospitalization was conducted comparing age, sex, hepatic encephalopathy (HE), serum albumin (ALB), creatinine (Cr), bilirubin (BILI), INR, MELD score, immunosuppression (IS), diabetes mellitus (DM) and ABX for SBP prophylaxis Conclusion There was no observed 2 week mortality or episodes of SBP after elective EVL in this patient group. Ascites and low serum albumin appear to be predictors of hospitalization in patients with cirrhosis after elective EVL. This study does not support the use of routine prophylactic antibiotics in patients with cirrhosis undergoing elective EVL even in the presence of ascites. Baseline characteristics of study group
AASLD Abstracts
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Aims -1. To determine liver and spleen stiffness values by ARFI for predicting esophageal varices. 2. Assessing whether combined LS and SS values are better than alone LS/SS values to predict esophageal varices. Material and Methods-All consecutive patients who were diagnosed as cirrhosis of liver due to any etiology for first time were included in this study. The control group included incidentally detected asymptomatic HBV infection (Disease control) and healthy volunteers. One senior Radiologist (SJ) who was blinded assessed the stiffness of liver and spleen by ARFI along with USG using Siemens Acuson S2000 ultrasound system (Siemens Medical Solutions, Mountain View, CA USA, while endoscopic evaluation was done by two gastroenterologist ( AKJ , SS ) who were also blinded. All cirrhosis patients were also assessed by calculating APRI indices. Results - This prospective study included 120 subjects [90- liver cirrhosis (case), 15 chronic Hepatitis B (control) and 15, healthy volunteers]. Liver stiffness was significantly higher in cirrhotic patients (2.49±0.49 met/sec) compared to chronic hepatitis B (1.22 ±0.30 met/sec) and healthy volunteers (1.11 ± 0.22 met/sec), (p = 0.0000).Similarly spleenic stiffness was significantly higher in cirrhotic patients (3.19 ± 0.46 met/sec) compared to chronic hepatitis B (2.21 ± 0.23 met/sec) and healthy volunteers (2.05 ± 0.15 met/sec).The best cut off value of LS obtained by ROC curve was 2.16 m/s for predicting esophageal varices. (AUROC 0.78, p 0.0002) with 81.11% accuracy ( Table 1 & Fig 1). The best cut off value of SS obtained by ROC curve was 3.04 m/s for predicting esophageal varices. (AUROC 0.698, p 0.0274,) with 68.88% accuracy (Table 1 & Fig 1). However when combined LS and SS together predicted esophageal varices in cirrhotic patients with 92.22% accuracy and was more accurate than SS or LS alone. We generated regression equation for predicting esophageal varcies based on multivariate regression analysis including liver stiffness and spleen stiffness as variate : Esophageal Varices = (0.225 LS + 0.377SS) - 0.555. All patients were divided into 3 groups according to. APRI indices < 0.5, 0.5-1.5 and >1.5. There was no statistically significant difference found (by one-way ANOVA) between LS (p=0.211) and SS (p=0.415) of cirrhosis patients divided on APRI basis. There was no significant difference between APRI index and esophageal variceal grade (Pearson Chi-Square = 2.837, DF = 4, ps-Value = 0.585, and liver and spleen stiffness (p values > 0.05). Table No 1. Assessment (Analysis/correlation) of EVs according to LS and SS
TABLE 1: CLINICAL PROFILE OF PATIENTS (n=57) WITH GASTRIC VARICES
ROC curve of liver stiffness and spleen stiffness measured by ARFI for predicting the presence of EVs
Su1508
AASLD Abstracts
Treatment Outcomes Following Glue Injection Without Lipiodol for Gastric Varices in South Indian Population Admitted to a Tertiary Care Centre Chandasekar S. Thoguluva, Viveksandeep C. Thogulva, Gokul J. Bollu, Sathiamoorthy Suriyanarayanan, Raja Yogesh Kalamegam, Prasad S. Menta BACKGROUND: Bleeding from gastric varices can be torrential and life-threatening in patients with portal hypertension. N-butyl-2-cyanoacrylate injection is one of the modalities of treating such varices. Large series using glue injection without lipiodol has not been reported in the literature. It is noteworthy that lipiodol has been routinely used in the West and it has been incriminated in the rare complication of pulmonary embolism associated with glue injection. AIM: To assess the efficacy and safety of glue injection without lipiodol in patients with gastric varices in South Indian population admitted to a tertiary care hospital. METHODS: The hospital records of consecutive patients who underwent gastric variceal glue injection without lipiodol between January 2011 and November 2015 were studied. All patients with portal hypertension (cirrhotic and non-cirrhotic etiologies) admitted with bleeding (active and recent) and those who never bled but had Child C cirrhosis with red signs over the fundal varices, were included. RESULTS: Fifty-seven patients (48 men, 9 women) underwent a total of seventy-five procedures. Mean age was 52.7 years (range 1775). Predominant etiologies for portal hypertension were cryptogenic and ethylic cirrhosis. Child A, B and C constituted 21.6%, 49 % and 29.4 % of cirrhotic patients respectively. Thirteen (22.8%) patients had a history of previous esophageal variceal bleed and 44 (77.2%) were on beta blockers at the time of presentation. Out of 75 procedures, 5 were done for active bleeding, 63 for recent bleeding and 7 for primary prophylaxis (patients with Child C cirrhosis and the presence of red signs). Immediate hemostasis was achieved in 5 out of 5 (100%) actively bleeding patients. Early rebleeding (within 48 hours) was observed in 2 out of 68 procedures and in both of them, a repeat glue injection was unsuccessful. Delayed rebleeding (48 hours-6 weeks) was observed in 4 out of 63 procedures. Rebleeding ever (after 6 weeks) occurred in 6 out of 45 patients. Ten patients required an average of 2.8 procedures due to rebleeding observed during the follow-up. In those who had long-term follow-up, eradication of gastric varices was noted in 26 out of 30 patients (86.7%). The mortality rate related to treatment failure was 2.7% (2 out of 75 procedures). CONCLUSION: These data were analyzed to know the treatment outcomes following glue injection of fundal varices without using lipiodol. In this series there was no complication of pulmonary or systemic embolism. Gluing of gastric varices without lipiodol is an effective and safe method for treating such varices.
TABLE 2: OUTCOMES AND COMPLICATIONS FOLLOWING GLUE INJECTION FOR GASTRIC VARICES
Su1509 Thromboelastography Does Not Correlate With Standard Measures of Hemostasis in Hospitalized Patients With Cirrhosis and Gastrointestinal Bleeding Eric Orman, Marwan Ghabril, Regina Weber, Jeffrey Kline, Cynthia Calley, Raj Vuppalanchi, Naga P. Chalasani Background: Standard measures of hemostasis do not predict bleeding risk in patients with cirrhosis. Alternative measures, such as thromboelastography (TEG), may have greater utility for the management of hospitalized patients with cirrhosis. We aimed to determine the characteristics of TEG and its correlation with standard measures of hemostasis in hospitalized patients with cirrhosis. Methods: Unselected patients with cirrhosis admitted to Indiana University Hospital were enrolled in a prospective study between June 2014 and October 2015. All patients had a sample of venous whole blood taken for TEG within 24 hours of
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AASLD Abstracts
Liver Cirrhosis Does Not Impair the Short-Term Outcome in Peptic Ulcer Bleeding Johanna M. Petersen, Aleksander Krag, Ove B. Schaffalitzky de Muckadell, Stig B. Laursen Objective: Variceal bleeding in patients with liver cirrhosis is associated with a considerable mortality around 10-20%. The outcome of peptic ulcer bleeding (PUB) in patients with liver cirrhosis compared to patients without cirrhosis has not been studied in detail. Method: Data were prospectively collected from consecutive patients admitted with PUB at our department through an 11-year period. We compared patient characteristics, bleeding episode, and outcome between patients with liver cirrhosis and patients without cirrhosis. Results: A total of 1002 patients were admitted with PUB during the period of inclusion. Thirty-five (3.5%) patients had cirrhosis. Compared to patients without liver cirrhosis patients with cirrhosis were younger (mean age: 58 vs 73 years; p < .001), were more often males (74% vs 54%; p=.02), more frequently had hemodynamic shock at time of admission to hospital (46% vs 29%; p=.039), a higher ASA-score (p=.005), high intake of alcohol (79% vs 12%; p<.0001), high frequency of daily smokers (78% vs 32%), and a longer duration of admission to hospital (mean: 7.5 vs 5.6 days; p=.018). However, patients with cirrhosis was only rarely diagnosed with cardiac disease (5.7% vs 42%; p<.0001) and only few had intake of aspirin (14% vs 50%; p=.001). There were no differences in B-hemoglobin (5.1 vs 5.4mmol/L), duodenal ulcer location (71% vs 57%), high-risk stigmata of bleeding (37% vs 39%), rate of rebleeding (20% vs 16%), or in-hospital mortality (8.6% vs 5.3%). Conclusions: Patients with PUB and cirrhosis are younger and only rarely diagnosed with cardiac comorbidity compared with PUB-patients without cirrhosis. Nevertheless, patients with cirrhosis and PUB have a high level of non-cardiac comorbidity and negative lifestyle factors that may explain the lack of difference in short-term mortality. Beside a difference in rate of hemodynamic shock, that may be explained by impaired cardiac response in cirrhotics, the character and severity of PUB seem similar in both groups of patients.
Multivariate analysis of factors predicting hospitalization
Su1507 Combined Noninvasive Evaluation of Liver and Spleen Stiffness By Acoustic Radiation Force Impulse (ARFI) for Assessment of Chronic Liver Disease and Portal Hypertension Suchita Jain, Ajay K. Jain, Amit K. Bundiwal, Shohini Sircar, Sandip G. Vare, Sandeep H. Kaulavkar, Mayank Jain, Rahul S. Agrawal, Suresh A. Hirani
Su1505 Shear Wave Elastography for the Assessment of Portal Hypertension Before and After Transjugular Intrahepatic Portosystemic Shunt Implantation, a Pilot Study Bo Wei, Chengwei Tang Objective: The objective of this study was to investigate the correlation between hepatic venous pressure gradient (HVPG) and liver stiffness measurement (LSM) before and after transjugular intrahepatic portosystemic shunt (TIPS) implantation. Materials and Methods: twelve patients with decompensated cirrhosis were examined twice by shear wave elastography (SWE)as well as prior and subsequent TIPS intervention; HVPG was also measured during TIPS placement. Results: All patients had decompensated cirrhosis yielding high LS , a decrease of LS after TIPS placement was observed (liver: 20.15 +/- 2.67kPa vs 17.06 +/1.87 kPa, P = 0.01). The changes were correlated with the relative change of HVPG (R2 = 0.419, P = 0.018). Conclusions: The observed linear correlation between LSM and HVPG raises the prospect of a reliable noninvasive assessment of portal pressure by shear wave elastography in the follow-up of TIPS placements.
Su1506 Predictors of Hospitalization After Elective Endoscopic Variceal Ligation in Cirrhosis V Sumana Kumarappa, Nigel Girgrah, Shobha Joshi, Natalie Bzowej, Gia Tyson, George Therapondos Introduction Endoscopic variceal ligation (EVL) is the treatment of choice for esophageal varices in cirrhosis and reportedly carries a 3-6% risk of bacteremia. Although antibiotics are strongly recommended in patients with active variceal bleeding, it is not known whether mortality, morbidity and hospitalization rates after elective EVL may be improved using a similar approach. Aims To record 2 week outcomes after elective EVL (both primary and secondary prophylaxis) in patients with cirrhosis. To identify predictors of hospitalization after this elective procedure. Methods This is a retrospective study (n =200) of all consecutive patients with cirrhosis who had elective EVL from Jan 2014 to Aug 2015 at a tertiary Liver Center. Detailed information regarding mortality, hospitalization and other critical events was recorded from the electronic health record for the 2 weeks after elective EVL. Results Baseline charactersitics of study group : Table 1 Hospitalizations: While there were no deaths, 17 patients were hospitalized (8.5%). Rate of hospitalization in patients with and without ascites was 11.9% (15/126) and 2.7% (2/74) respectively (p = 0.03). Most of the admissions (15/17) were observed in patients with ascites. In the ascites patients, 2/17(11.7%) on antibiotics (ABX) for prophylaxis of spontaneous bacterial peritonitis (SBP) were hospitalized vs 13/109(11.9%) not on ABX for SBP prohylaxis (p =NS). Causes of hospitalizations: Gastrointestinal bleed (5/17), worsening ascites (6/17), fever (1/17), cellulitis(1/17), TACE(1/ 17), liver transplant (2/17) Predictors of hospitalization: Table 2 A multivariate analysis to predict risk factors for hospitalization was conducted comparing age, sex, hepatic encephalopathy (HE), serum albumin (ALB), creatinine (Cr), bilirubin (BILI), INR, MELD score, immunosuppression (IS), diabetes mellitus (DM) and ABX for SBP prophylaxis Conclusion There was no observed 2 week mortality or episodes of SBP after elective EVL in this patient group. Ascites and low serum albumin appear to be predictors of hospitalization in patients with cirrhosis after elective EVL. This study does not support the use of routine prophylactic antibiotics in patients with cirrhosis undergoing elective EVL even in the presence of ascites. Baseline characteristics of study group
AASLD Abstracts
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Aims -1. To determine liver and spleen stiffness values by ARFI for predicting esophageal varices. 2. Assessing whether combined LS and SS values are better than alone LS/SS values to predict esophageal varices. Material and Methods-All consecutive patients who were diagnosed as cirrhosis of liver due to any etiology for first time were included in this study. The control group included incidentally detected asymptomatic HBV infection (Disease control) and healthy volunteers. One senior Radiologist (SJ) who was blinded assessed the stiffness of liver and spleen by ARFI along with USG using Siemens Acuson S2000 ultrasound system (Siemens Medical Solutions, Mountain View, CA USA, while endoscopic evaluation was done by two gastroenterologist ( AKJ , SS ) who were also blinded. All cirrhosis patients were also assessed by calculating APRI indices. Results - This prospective study included 120 subjects [90- liver cirrhosis (case), 15 chronic Hepatitis B (control) and 15, healthy volunteers]. Liver stiffness was significantly higher in cirrhotic patients (2.49±0.49 met/sec) compared to chronic hepatitis B (1.22 ±0.30 met/sec) and healthy volunteers (1.11 ± 0.22 met/sec), (p = 0.0000).Similarly spleenic stiffness was significantly higher in cirrhotic patients (3.19 ± 0.46 met/sec) compared to chronic hepatitis B (2.21 ± 0.23 met/sec) and healthy volunteers (2.05 ± 0.15 met/sec).The best cut off value of LS obtained by ROC curve was 2.16 m/s for predicting esophageal varices. (AUROC 0.78, p 0.0002) with 81.11% accuracy ( Table 1 & Fig 1). The best cut off value of SS obtained by ROC curve was 3.04 m/s for predicting esophageal varices. (AUROC 0.698, p 0.0274,) with 68.88% accuracy (Table 1 & Fig 1). However when combined LS and SS together predicted esophageal varices in cirrhotic patients with 92.22% accuracy and was more accurate than SS or LS alone. We generated regression equation for predicting esophageal varcies based on multivariate regression analysis including liver stiffness and spleen stiffness as variate : Esophageal Varices = (0.225 LS + 0.377SS) - 0.555. All patients were divided into 3 groups according to. APRI indices < 0.5, 0.5-1.5 and >1.5. There was no statistically significant difference found (by one-way ANOVA) between LS (p=0.211) and SS (p=0.415) of cirrhosis patients divided on APRI basis. There was no significant difference between APRI index and esophageal variceal grade (Pearson Chi-Square = 2.837, DF = 4, ps-Value = 0.585, and liver and spleen stiffness (p values > 0.05). Table No 1. Assessment (Analysis/correlation) of EVs according to LS and SS
TABLE 1: CLINICAL PROFILE OF PATIENTS (n=57) WITH GASTRIC VARICES
ROC curve of liver stiffness and spleen stiffness measured by ARFI for predicting the presence of EVs
Su1508
AASLD Abstracts
Treatment Outcomes Following Glue Injection Without Lipiodol for Gastric Varices in South Indian Population Admitted to a Tertiary Care Centre Chandasekar S. Thoguluva, Viveksandeep C. Thogulva, Gokul J. Bollu, Sathiamoorthy Suriyanarayanan, Raja Yogesh Kalamegam, Prasad S. Menta BACKGROUND: Bleeding from gastric varices can be torrential and life-threatening in patients with portal hypertension. N-butyl-2-cyanoacrylate injection is one of the modalities of treating such varices. Large series using glue injection without lipiodol has not been reported in the literature. It is noteworthy that lipiodol has been routinely used in the West and it has been incriminated in the rare complication of pulmonary embolism associated with glue injection. AIM: To assess the efficacy and safety of glue injection without lipiodol in patients with gastric varices in South Indian population admitted to a tertiary care hospital. METHODS: The hospital records of consecutive patients who underwent gastric variceal glue injection without lipiodol between January 2011 and November 2015 were studied. All patients with portal hypertension (cirrhotic and non-cirrhotic etiologies) admitted with bleeding (active and recent) and those who never bled but had Child C cirrhosis with red signs over the fundal varices, were included. RESULTS: Fifty-seven patients (48 men, 9 women) underwent a total of seventy-five procedures. Mean age was 52.7 years (range 1775). Predominant etiologies for portal hypertension were cryptogenic and ethylic cirrhosis. Child A, B and C constituted 21.6%, 49 % and 29.4 % of cirrhotic patients respectively. Thirteen (22.8%) patients had a history of previous esophageal variceal bleed and 44 (77.2%) were on beta blockers at the time of presentation. Out of 75 procedures, 5 were done for active bleeding, 63 for recent bleeding and 7 for primary prophylaxis (patients with Child C cirrhosis and the presence of red signs). Immediate hemostasis was achieved in 5 out of 5 (100%) actively bleeding patients. Early rebleeding (within 48 hours) was observed in 2 out of 68 procedures and in both of them, a repeat glue injection was unsuccessful. Delayed rebleeding (48 hours-6 weeks) was observed in 4 out of 63 procedures. Rebleeding ever (after 6 weeks) occurred in 6 out of 45 patients. Ten patients required an average of 2.8 procedures due to rebleeding observed during the follow-up. In those who had long-term follow-up, eradication of gastric varices was noted in 26 out of 30 patients (86.7%). The mortality rate related to treatment failure was 2.7% (2 out of 75 procedures). CONCLUSION: These data were analyzed to know the treatment outcomes following glue injection of fundal varices without using lipiodol. In this series there was no complication of pulmonary or systemic embolism. Gluing of gastric varices without lipiodol is an effective and safe method for treating such varices.
TABLE 2: OUTCOMES AND COMPLICATIONS FOLLOWING GLUE INJECTION FOR GASTRIC VARICES
Su1509 Thromboelastography Does Not Correlate With Standard Measures of Hemostasis in Hospitalized Patients With Cirrhosis and Gastrointestinal Bleeding Eric Orman, Marwan Ghabril, Regina Weber, Jeffrey Kline, Cynthia Calley, Raj Vuppalanchi, Naga P. Chalasani Background: Standard measures of hemostasis do not predict bleeding risk in patients with cirrhosis. Alternative measures, such as thromboelastography (TEG), may have greater utility for the management of hospitalized patients with cirrhosis. We aimed to determine the characteristics of TEG and its correlation with standard measures of hemostasis in hospitalized patients with cirrhosis. Methods: Unselected patients with cirrhosis admitted to Indiana University Hospital were enrolled in a prospective study between June 2014 and October 2015. All patients had a sample of venous whole blood taken for TEG within 24 hours of
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AASLD Abstracts