Bleeding after paracentesis in patients with decompensated cirrhosis and acute kidney injury: the perfect storm

We read with great interest the recently published study by Hung and Garcia-Tsao that identified the presence of acute kidney injury (AKI) as the most important predictor of bleeding following paracentesis in patients with decompensated cirrhosis.1 Indeed, although the yield of this study results may be limited by its setting (retrospective, chart review), we feel that the authors should be complimented for their effort in trying to provide a clinical evidence for a pathophysiological hypothesis that was mainly suggested by experts' panel opinions.2 As a fact, this study confirms the hypothesis that the acute perturbance of renal function - but not as a chronic condition since the prevalence of renal failure was similar in patients with bleeding events and controls - may induce a derangement in the coagulation balance of cirrhotic patients when this feeble balance is challenged by an invasive procedure such as paracentesis. This article is protected by copyright. All rights reserved.