Platelet count does not predict bleeding in cirrhotic patients: Results from the PRO-LIVER Study

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RESEARCH PRODUCT

Platelet count does not predict bleeding in cirrhotic patients: Results from the PRO-LIVER Study

S. A Basili V. B. Raparelli L. B. Napoleone G. A. Talerico G. R. C. Corazza F. D. Perticone D. E. Sacerdoti A. F. Andriulli A. G. Licata A. Pietrangelo A. I. Picardi G. J. Raimondo F. Violi G. Palasciano F. D’alitto V. O. Palmieri D. Santovito Di Michele D. Croce G. Brocco S. Fasolato S. Cecchetto L. Bombonato G. Bertoni M. Restuccia T. Andreozzi P. Liguori M. L. Caroleo B. Perticone M. Staltari O. Manfredini De Giorgi A. Averna M. Giammanco A. Granito A. Pettinari I. Marinelli S. Bolondi L. Falsetti L. Salvi A. Durante-mangoni E. Cesaro F. Farinaro V. Ragone E. Morana I. Ippolito A. Iacobellis A. Niro G. Merla A. Maimone S. Cacciola I. Varvara D. Drenaggi D. Staffolani S. Vespasiani-gentilucci U. Galati G. Gallo P. Davì G. Schiavone C. Santilli F. Tana C. Soresi Giovanni Bianchi B. Carderi I. Pinto A. Tuttolomondo A. Ferrari G. Gresele P. Fierro T. Morelli O. Laffi G. Romanelli R. G. Arena U. Stasi A. Gasbarrini M. Garcovich M. A. Zocco L. Riccardi M. E. Ainora W. Capeci Giuseppe Martino P. Nobili L. Cavallo M. Frugiuele P. Greco P. Ventura C. Cuoghi M. Marcacci G. Serviddio G. Vendemiale R. Villani R. Gargano G. Vidili Di Cesare V. Masala M. Delitala G. Invernizzi P. Vincenzo Di Minno G. Tufano A. Purrello F. Privitera G. Forgione A. Curigliano V. Senzolo M. Rodríguez-castro K. I. Giannelli G. Serra C. Neri S. Pignataro P. Rizzetto M. Debernardi V. W. Svegliati B. G. Bergamaschi G. Masotti M. Costanzo F. Antonio F. Angelico Ben Del M. Polimeni L. Proietti M. Cangemi R. Romiti G. F. Toriello F. Sperduti N. Santangelo G. Visioli G. Todisco Anna Vestri R. Farcomeni A. Corrao S. Gobbi E. Corradini G. Costantino G. Tripepi M. Angelico L. Bolondi A. Granito G. D’amico De Franchis R. Gatta A. Tassone E. J. Anzaldi M. Barone M. Bazzini C. Bianchi P. I. Boari B. Bracco C. Buonauro A. Buttà E. Buzzetti S. Calabria F. Caradio P. Carleo Maria Carrabba D. Castorani L. Cecchetto L. Cicco S. Cimini C. Colombo B. M.De Giorgi De Vuono S. Denegri Corso Del Di Giosia P. Donnarumma E. Giorgini P. Grassi D. Grembiale A. Hijazi D. Iamele L. Lorusso G. Marchese Alberto Marra M. Masala M. Miceli G. Montebianco A. L. Murgia G. Naccarato P. Padula D. Pattoneri P. Perego F. Pesce P. Petramala L. Piano S. Pinto D. Pinna M. Pignataro F. S. Pretti V. Pucci G. Salinaro F. Salzano A. Santarossa C. Scarpini F. Scicali R. Sirico D. Suppressa P. Talia M. Torres D. Traversa M. Vazzana Claudia Vecchio R. Vettore E. Vitale

subject

Liver Cirrhosis Male Settore MED/09 - Medicina Interna 030204 cardiovascular system & hematology Gastroenterology Severity of Illness Index cjirrhosis ACTIVATION 0302 clinical medicine Risk Factors Medicine Platelet Prospective Studies Prospective cohort study RISK Aged 80 and over medicine.diagnostic_test PRO-LIVER Platelet cirrhosis gastrointestinal bleeding Platelet Gastroenterology ASSOCIATION Middle Aged Prognosis Italy 030211 gastroenterology & hepatology Female Gastrointestinal Hemorrhage Human Adult Platelets medicine.medical_specialty Prognosi Liver Cirrhosi MEDLINE COAGULATION gastrointestinal bleeding Socio-culturale Hemorrhage Hepatology; Gastroenterology Follow-Up Studie 03 medical and health sciences Text mining Internal medicine Severity of illness ENDOTOXEMIA Pro-Liver Study Humans HEMOSTASIS International Normalized Ratio Aged Proportional Hazards Models Prothrombin time Cirrhosi Hepatology Platelet Count Bleeding Liver Cirrhosis business.industry Proportional hazards model Platelet Count Risk Factor cirrhosis Hepatology bleeding Thrombocytopenia Prospective Studie THROMBOSIS Platelets cjirrhosis bleeding PRO-LIVER Proportional Hazards Model Prothrombin Time business DECOMPENSATED CIRRHOSIS Follow-Up Studies

description

OBJECTIVES: Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship between platelet count and bleeding is still unclear. METHODS: We investigated the relationship between platelet count and major or clinical relevant nonmajor bleedings during a follow-up of â¼4 years. RESULTS: A total of 280 cirrhotic patients with different degrees of liver disease (67% males; age 64Â±37 years; 47% ChildâPugh B and C) were followed up for a median of 1,129 (interquartile range: 800â1,498) days yielding 953.12 patient-year of observation. The annual rate of any significant bleeding was 5.45%/year (3.57%/year and 1.89%/year for major and minor bleeding, respectively). Fifty-two (18.6%) patients experienced a major (n=34) or minor (n=18) bleeding event, predominantly from gastrointestinal origin. Platelet counts progressively decreased with the worsening of liver disease and were similar in patients with or without major or minor bleeding: a platelet count â¤50Ã103/Î¼l was detected in 3 (6%) patients with and in 20 (9%) patients without any bleeding event. Conversely, prothrombin time-international normalized ratio was slightly higher in patients with overall or major bleeding. On Cox proportional hazard analysis, only a previous gastrointestinal bleeding (hazard ratio (HR): 1.96; 95% confidence interval: 1.11â3.47; P=0.020) and encephalopathy (HR: 2.05; 95% confidence interval: 1.16â3.62; P=0.013) independently predicted overall bleeding events. CONCLUSIONS: Platelet count does not predict unprovoked major or minor bleeding in cirrhotic patients.

year	journal	country	edition	language
2018-01-01

10.1038/ajg.2017.457 https://hdl.handle.net/11391/1545373