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Determinants of platelet count are different in patients with compensated and decompensated cirrhosis

2015; Wiley; Volume: 36; Issue: 2 Linguagem: Inglês

10.1111/liv.12908

1478-3231

Raquel García Latorre, Javier Vaquero, Diego Rincón, Marta Puerto, María D. Ponce, Fernando Sarnago, José A. Matamoros, Enrique de Ramón, Jaime Elı́zaga, Rafael Bañares, Cristina Ripoll,

Hepatocellular Carcinoma Treatment and Prognosis

Abstract Background & Aims Different mechanisms including portal hypertension and hypersplenism have been involved in the development of thrombocytopenia in cirrhosis. However, the relative contribution of each one is unknown. The aim was to evaluate simultaneously different mechanisms that determine platelet count in cirrhosis. Methods Cross‐sectional study including cirrhotics ( n = 120) with hepatic venous pressure gradient ( HVPG ) measurement. Samples were obtained from peripheral (P) veins to evaluate thrombopoietin ( TPO ), stem cell factor, hepatocyte growth factor ( HGF ), tumour necrosis factor, interleukin‐(IL6) and (IL11) and from hepatic (H) veins to evaluate TPO . A subgroup ( n = 72) had spleen volume estimation. H and P‐ TPO were also measured in non‐cirrhotic patients ( n = 15). Results Patients (Child A: 55, B: 43, C: 22) had a median platelet count of 81 000/mm 3 ( IQR 60 500, 110 750), which correlated with spleen volume ( r = −0.38, P < 0.001). Platelets were associated also to HVPG ( r = −0.47, P = 0.004) and P‐ TPO ( r = 0.31, P = 0.050) only in compensated patients. H‐ TPO decreased, and the proportion of patients with P‐TPO > H‐TPO increased, with the presence and the severity of liver disease. H‐TPO was correlated with liver function (bilirubin r = −0.350, P < 0.001 and international normalized ratio r = −0.227, P = 0.011). Patients with H‐TPO < P‐TPO had higher levels of IL ‐11 and HGF . Conclusion Platelet count in cirrhosis is associated mainly to spleen volume, although portal hypertension as estimated by HVPG and liver function plays a significant role in compensated patients. H‐ TPO and the proportion of patients with P‐TPO > H‐ TPO were associated to the presence and severity of liver disease.