血小板计数较低与慢加急性肝衰竭患者 90 天不良结局相关。

Lower platelet counts were associated with 90-day adverse outcomes in acute-on-chronic liver disease patients.

机构信息

Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Hepatology, Chenzhou No. 1 People's Hospital, Chenzhou, China.

Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Ann Palliat Med. 2021 Sep;10(9):9342-9353. doi: 10.21037/apm-21-1019. Epub 2021 Aug 13.

DOI:10.21037/apm-21-1019

PMID:34412498

Abstract

BACKGROUND

Chronic liver diseases (CLD), including cirrhosis and non-cirrhotic liver diseases, are globally widespread and create a serious disease burden. Platelet count is a clinically accessible and affordable prognostic indicator of liver disease. We investigated the relationship between platelet count and 90-day prognosis in patients with acute-on-chronic liver diseases (AoCLD).

METHODS

A total of 3,970 patients with AoCLD from the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study, which included two prospective multi-center cohorts, were included in the study. We grouped the patients according to the platelet count and analyzed the 90-day adverse outcome (death or liver transplantation).

RESULTS

In the final analysis, 3,939 patients with AoCLD were included, of whom 2,802 had definite liver cirrhosis. The cumulative incidence of 90-day adverse outcomes in patients increased with the change of platelet group (log-rank P<0.001). From univariate and multivariate analyses, platelet count was inversely associated with the incidence of 90-day adverse outcomes in patients (P for trend <0.001). The group with platelet count <20×109/L had the highest risk (odds ratio, 3.15; 95% confidence interval, 1.59-6.25), with 21 (36.8%) of these patients having adverse outcomes within 90 days. The risk of a 90-day adverse outcome in patients increased by 5% for every 10×109/L decrease in platelet count below 210×109/L.

CONCLUSIONS

Lower platelet count was associated with a higher incidence of 90-day adverse outcomes in patients with AoCLD. Even within the normal platelet count range, the risk of a 90-day adverse outcome in patients increased with decreases in platelet count.

TRIAL REGISTRATION

NCT02457637, NCT03641872.

摘要

背景

慢性肝病（CLD），包括肝硬化和非肝硬化性肝病，在全球范围内广泛存在，造成了严重的疾病负担。血小板计数是一种临床可及且负担得起的肝病预后指标。我们研究了血小板计数与急性肝衰竭患者 90 天预后的关系。

方法

本研究纳入了来自中国急性肝衰竭研究（CATCH-LIFE）的 3970 例急性肝衰竭患者，该研究包括两个前瞻性多中心队列。我们根据血小板计数对患者进行分组，并分析了 90 天不良结局（死亡或肝移植）。

结果

最终纳入 3939 例急性肝衰竭患者，其中 2802 例明确存在肝硬化。随着血小板组的变化，患者 90 天不良结局的累积发生率增加（对数秩检验 P<0.001）。单因素和多因素分析均显示，血小板计数与患者 90 天不良结局的发生率呈负相关（趋势 P<0.001）。血小板计数<20×109/L 的患者发生 90 天不良结局的风险最高（比值比 3.15；95%置信区间 1.59-6.25），其中 21 例（36.8%）在 90 天内出现不良结局。血小板计数每降低 10×109/L，患者发生 90 天不良结局的风险增加 5%，而血小板计数<210×109/L 时风险增加。