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Determinants of platelet count are different in patients with compensated and decompensated cirrhosis
Author(s) -
Latorre Raquel,
Vaquero Javier,
Rincón Diego,
Puerto Marta,
Ponce María D.,
Sarnago Fernando,
Matamoros Jose A.,
Ramón Enrique,
Elizaga Jaime,
Bañares Rafael,
Ripoll Cristina
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12908
Subject(s) - medicine , thrombopoietin , cirrhosis , platelet , portal hypertension , portal venous pressure , gastroenterology , spleen , liver function , endocrinology , stem cell , genetics , haematopoiesis , biology
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.