Platelet count does not predict bleeding in cirrhotic patients
In cirrhotic patients, platelet count does not appear to have significant predictive value for unprovoked major or minor bleeding, a recent study has shown.
Researchers recruited 280 consecutive cirrhotic patients (mean age 64±37 years; 188 males) in whom the severity of liver disease was assessed using the Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. Cox proportional hazards analysis was performed to determine associations between outcomes and clinical variables.
Major bleeding events were reported in 34 patients (12 percent), most of whom (91 percent; n=31) had bleeding related to portal hypertension; the remaining cases were due to intracerebral and bronchial tree haemorrhage. Six patients died due to major bleeding.
MELD scores were significantly higher (13.3±5.7 vs 10.9±5.5; p=0.0215) and encephalopathy was significantly more frequent (41 percent vs 19.5 percent; p=0.017) in patients who experienced major bleeding.
Previous gastrointestinal bleeding (hazard ratio [HR], 2.40; p=0.012) and hepatic encephalopathy (HR, 2.47; p=0.010) were significant and independent predictors of major bleeding in the fully-adjusted models.
Only 18 patients showed minor bleeding over a median follow-up of 186 days, yielding an annual rate of 1.89 percent.
Between bleeders and nonbleeders, only the Child-Pugh (p=0.0461) and MELD (p=0.0193) scores, presence of encephalopathy (p=0.0071), previous gastrointestinal bleeding events (p=0.0117), serum albumin (p=0.0373) and prothrombin time-international normalized ratio (p=0.0029) were significantly different.
Platelet counts, the presence of ascites, age, sex, disease aetiology, serum levels of creatinine and bilirubin, and use of β-blockers and aldosterone receptor agonists were statistically comparable between the two patient groups.