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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 2
Feb.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(2): 381-386

Effect of platelet level and platelet parameters on the prognosis of patients with acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2022.02.023
  • 1.

    Department of Gastroenterology, Branch of Tianjin Third Central Hospital, Tianjin 300250, China

  • 2.

    Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin 300170, China

Research funding:

The Third "Sansheng TCP Young and Middle-Aged Scientific Research Fund" 

More Information
  • Corresponding author: LIANG Jing, haolele77@sina.com
  • Received Date: 2021-05-30
  • Accepted Date: 2021-09-24
  • Published Date: 2022-02-20
    Abstract
  •   Objective  To investigate the differences in platelet and platelet parameters between patients with different types and etiologies of acute-on-chronic liver failure (ACLF) and the influence of platelet and its dynamic change on the prognosis of ACLF patients.  Methods  Clinical data, liver function parameters, platelet, and platelet parameters were collected from 364 patients with ACLF who attended Tianjin Third Central Hospital from January 2014 to December 2018. Platelet level and platelet parameters (platelet distribution width and mean platelet volume) were compared between the patients with different types and etiologies of ACLF, and their influence on the 90-day mortality rate of ACLF patients was analyzed, as well as the association of the dynamic change of platelet at baseline and on days 7 and 14 after admission with the prognosis of patients. The chi-square test was used for comparison of categorical data between groups; the Kruskal-Wallis H test or Mann-Whitney U test was used for comparison of continuous data between groups; the Kaplan-Meier method was used for survival analysis; the univariate and multivariate Cox regression analyses were used to analyze the parameters associated with prognosis; the repeated measures analysis of variance was used to analyze the dynamic change of platelet; receiver operating characteristic (ROC) curve was plotted based on platelet level and overall survival.  Results  The patients with type C ACLF had a significantly lower platelet level than those with type A/B ACLF (all P < 0.001). Compared with the ACLF patients with hepatitis B, the ACLF patients with autoimmune liver diseases had a significant reduction in mean platelet volume (P=0.035). Based on the cut-off value obtained by the ROC curve analysis, the patients with a platelet level of < 60.5×109/L had a significantly higher mortality rate than those with a platelet level of ≥60.5×109/L (P=0.006). Platelet level was an independent protective factor against 90-day death in ACLF patients (hazard ratio=0.995, 95% confidence interval: 0.990-0.999, P=0.026), and the mortality rate increased with the reduction in platelet level. The patients with type C ACLF had a significantly higher mortality rate than those with type A ACLF (P < 0.05), and the death group tended to have a significantly greater reduction in platelet level (P < 0.05). Compared with the survival group, the 90-day death group had a significantly greater reduction in platelet (P=0.032).  Conclusion  There is a difference in platelet level between ACLF patients with different types. Platelet level is an important indicator for the 90-day prognosis of ACLF patients, and patients with a greater dynamic reduction in platelet tend to have a higher 90-day mortality rate.

     

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    • References(26)
  • [1]
    GUSTOT T, FERNANDEZ J, GARCIA E, et al. Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis[J]. Hepatology, 2015, 62(1): 243-252. DOI: 10.1002/hep.27849.
    [2]
    LI YL, YANG XL, LIU XJ, et al. Regulatory effects of immune cells on acute-on-chronic liver failure[J/CD]. Chin J Liver Dis (Electronic Version), 2020, 12(2): 42-46. DOI: 10.3969/j.issn.1674-7380.2020.02.008.

    李彦霖, 杨雪亮, 刘小静, 等. 免疫细胞在慢加急性肝衰竭中的调控作用[J/CD]. 中国肝脏病杂志(电子版), 2020, 12(2): 42-46. DOI: 10.3969/j.issn.1674-7380.2020.02.008.
    [3]
    ISHIKAWA T, ICHIDA T, MATSUDA Y, et al. Reduced expression of thrombopoietin is involved in thrombocytopenia in human and rat liver cirrhosis[J]. J Gastroenterol Hepatol, 1998, 13(9): 907-913. DOI: 10.1111/j.1440-1746.1998.tb00760.x.
    [4]
    ASTER RH. Pooling of platelets in the spleen: Role in the pathogenesis of "hypersplenic" thrombocytopenia[J]. J Clin Invest, 1966, 45(5): 645-657. DOI: 10.1172/JCI105380.
    [5]
    OLARIU M, OLARIU C, OLTEANU D. Thrombocytopenia in chronic hepatitis C[J]. J Gastrointestin Liver Dis, 2010, 19(4): 381-385.
    [6]
    LISMAN T, BONGERS TN, ADELMEIJER J, et al. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity[J]. Hepatology, 2006, 44(1): 53-61. DOI: 10.1002/hep.21231.
    [7]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [8]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [9]
    MALINCHOC M, KAMATH PS, GORDON FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J]. Hepatology, 2000, 31(4): 864-871. DOI: 10.1053/he.2000.5852.
    [10]
    JALAN R, YURDAYDIN C, BAJAJ JS, et al. Toward an improved definition of acute-on-chronic liver failure[J]. Gastroenterology, 2014, 147(1): 4-10. DOI: 10.1053/j.gastro.2014.05.005.
    [11]
    KHODADI E. Platelet function in cardiovascular disease: Activation of molecules and activation by molecules[J]. Cardiovasc Toxicol, 2020, 20(1): 1-10. DOI: 10.1007/s12012-019-09555-4.
    [12]
    SHIDO K, CHAVEZ D, CAO Z, et al. Platelets prime hematopoietic and vascular niche to drive angiocrine-mediated liver regeneration[J]. Signal Transduct Target Ther, 2017, 2: 16044. DOI: 10.1038/sigtrans.2016.44.
    [13]
    TAKAHASHI K, NAGAI S, COLLINS KM, et al. Factors associated with low graft regeneration in the early phase after living donor liver transplantation[J]. Clin Transplant, 2019, 33(10): e13690. DOI: 10.1111/ctr.13690.
    [14]
    GIANNINI EG, GRECO A, MARENCO S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease[J]. Clin Gastroenterol Hepatol, 2010, 8(10): 899-902; quiz e109. DOI: 10.1016/j.cgh.2010.06.018.
    [15]
    ABDEL-RAZIK A, ELDARS W, RIZK E. Platelet indices and inflammatory markers as diagnostic predictors for ascitic fluid infection[J]. Eur J Gastroenterol Hepatol, 2014, 26(12): 1342-1347. DOI: 10.1097/MEG.0000000000000202.
    [16]
    EKIZ F, YÜKSEL O, KOÇAK E, et al. Mean platelet volume as a fibrosis marker in patients with chronic hepatitis B[J]. J Clin Lab Anal, 2011, 25(3): 162-165. DOI: 10.1002/jcla.20450.
    [17]
    HAN L, HAN T, NIE C, et al. Elevated mean platelet volume is associated with poor short-term outcomes in hepatitis B virus-related acute-on-chronic liver failure patients[J]. Clin Res Hepatol Gastroenterol, 2015, 39(3): 331-339. DOI: 10.1016/j.clinre.2014.10.006.
    [18]
    XU Y, HUANG XP, CHEN L, et al. Value of mean platelet volume in evaluating the prognosis of hepatitis B virus associated acute on chronic liver failure[J]. J Clin Hepatol, 2020, 36(10): 2199-2202. DOI: 10.3969/j.issn.1001-5256.2020.10.008.

    徐英, 黄小平, 陈丽, 等. 平均PLT体积对HBV相关慢加急性肝衰竭预后的评估价值[J]. 临床肝胆病杂志, 2020, 36(10): 2199-2202. DOI: 10.3969/j.issn.1001-5256.2020.10.008.
    [19]
    ABDEL-RAZIK A, MOUSA N, ZAKARIA S, et al. New predictive factors of poor response to therapy in autoimmune hepatitis: Role of mean platelet volume[J]. Eur J Gastroenterol Hepatol, 2017, 29(12): 1373-1379. DOI: 10.1097/MEG.0000000000000982.
    [20]
    CHAUHAN A, ADAMS DH, WATSON SP, et al. Platelets: No longer bystanders in liver disease[J]. Hepatology, 2016, 64(5): 1774-1784. DOI: 10.1002/hep.28526.
    [21]
    MILOVANOVIC ALEMPIJEVIC T, STOJKOVIC LALOSEVIC M, DUMIC I, et al. Diagnostic accuracy of platelet count and platelet indices in noninvasive assessment of fibrosis in nonalcoholic fatty liver disease patients[J]. Can J Gastroenterol Hepatol, 2017, 2017: 6070135. DOI: 10.1155/2017/6070135.
    [22]
    DELGADO-GARCÍA G, GALARZA-DELGADO DÁ, COLUNGA-PEDRAZA I, et al. Mean platelet volume is decreased in adults with active lupus disease[J]. Rev Bras Reumatol Engl Ed, 2016, 56(6): 504-508. DOI: 10.1016/j.rbre.2016.03.003.
    [23]
    KISACIK B, TUFAN A, KALYONCU U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis[J]. Joint Bone Spine, 2008, 75(3): 291-294. DOI: 10.1016/j.jbspin.2007.06.016.
    [24]
    PENG YF, HUANG YX, WEI YS. Altered mean platelet volume in patients with polymyositis and its association with disease severity[J]. Braz J Med Biol Res, 2016, 49(6): e5168. DOI: 10.1590/1414-431X20165168.
    [25]
    YANG MR, ZHOU ZP. Update of clinical characteristics and treatment of secondary ITP from autoimmune diseases[J]. Chin J Immunol, 2021, 37(3): 361-366. DOI: 10.3969/j.issn.1000-484X.2021.03.019.

    杨慕然, 周泽平. 免疫性疾病继发性ITP临床特点及治疗研究进展[J]. 中国免疫学杂志, 2021, 37(3): 361-366. DOI: 10.3969/j.issn.1000-484X.2021.03.019.
    [26]
    SCHMOELLER D, PICARELLI MM, PAZ MUNHOZ T, et al. Mean platelet volume and immature platelet fraction in autoimmune disorders[J]. Front Med (Lausanne), 2017, 4: 146. DOI: 10.3389/fmed.2017.00146.
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