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Evaluation of Risk Factors for Bleeding After Liver Biopsy in Children

Westheim, Birgitte H.*; Østensen, Anniken B.; Aagenæs, Ingegerd; Sanengen, Truls; Almaas, Runar*

Erratum

In the article that appeared on page 82 of the July 2012 issue, information was omitted from the Methods and Results sections. In the subsection Statistical Analysis, the paragraph should have read:

The effect of risk factors on complication rate was studied using the Fisher exact test. Data are given as odds ratio with 95% confidence interval. Univariate regression was also used. Variables from the univariate model with a P < 0.20 were included in the multivariate analyses in addition to age and transplantation, which were forced in. Comparison of drop in Hb between children younger than 3 months and older than 1 year was done with an unpaired Student t test. A 2-tailed P < 0.05 was considered statistically significant. Calculations were performed with GraphPad Instat version 03.10 for Windows (GraphPad Software Inc, San Diego, CA) and PASW-18 (SPSS Inc, Chicago, IL).

The subsection following Transplantation should have been Prediction (rather than Regression) and the text for this section should have read:

 Univariate logistic regression with “all bleeding” (both major and minor bleeding) as the dependent factor demonstrated P < 0.20 for LMWH (P = 0.11) and focal lesion (P = 0.042) (Table 4). These 2 were included in a multivariate regression model together with age and transplantation, which were forced in. Although LMWH (P = 0.028, OR 5.49, CI 1.21–24.9) made a significant contribution, focal lesion (P = 0.108, OR 2.38, CI 0.83–6.82) was not significant in this model.

 Univariate logistic regression with “major bleeding” as the dependent factor resulted in P < 0.20 for focal lesion (P = 0.187), LMWH (P = 0.097), and acute liver failure (P = 0.05). These 3 were included in a multivariate regression model together with age and transplantation, which were forced in, and only acute liver failure (P = 0.038, OR 27.3, CI 1.20–6.23) made a significant contribution.

 Univariate logistic regression with “minor bleeding” as the dependent factor resulted in P < 0.20 just for focal lesion (P = 0.098), and no multivariate regression model was made.

The body of Table 4 should be replaced by the following:

Journal of Pediatric Gastroenterology and Nutrition. 55(2):235, August 2012.

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e318249c12a
Original Articles: Hepatology and Nutrition
Abstract

Objectives: Acetylsalicylic acid is used in liver-transplanted children to prevent thrombosis of the hepatic artery. We evaluated whether acetylsalicylic acid and other risk factors were associated with bleeding after percutaneous liver biopsy.

Methods: Medical charts, laboratory results, imaging studies, and anesthesia charts of 275 ultrasound-guided liver biopsy procedures in 190 children were reviewed. A total of 178 biopsies were performed on native livers and 97 on transplanted livers.

Results: Three major and 28 minor bleeding incidents were found. The mortality rate was 0%. Acetylsalicylic acid had been given the last 5 days before 55 of the biopsy procedures and no increased risk of bleeding was found (odds ratio 0.96 [0.37–2.26]; P = 1.00). Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Acute liver failure was associated with increased risk for major complications (odds ratio 26.1 [3.3–205]; P = 0.01) and was a risk factor for major bleeding. Postbiopsy ultrasound the day after the procedure (n = 266 [96% of 275 biopsies]) revealed minor bleeding after 7.1% of the biopsies and after 2.6% of the ultrasounds revealed unsuspected bleeding, but none of these required intervention.

Conclusions: Ultrasound-guided liver biopsy in children is a procedure with a low rate of major complications and a high rate of minor bleeding not requiring intervention. Treatment with low-dose acetylsalicylic acid did not increase bleeding incidence or total complication rate. Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Routine ultrasound the day after the procedure did not change handling of the patients.

Author Information

*Department of Pediatric Research

Department of Pediatrics

Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.

Address correspondence and reprint requests to Almaas Runar, MD, PhD, Department of Pediatric Research, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway (e-mail: runar.almaas@ous-hf.no).

Received 3 October, 2011

Accepted 5 January, 2012

The present study was supported by the Eckbo Foundation and by the Grimsgaard Foundation.

B.H.W. has received grants from the Faculty of Medicine, University of Oslo. The other authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN