Biswas Sagnik, Vaishnav Manas, Pathak Piyush, Gunjan Deepak, Mahapatra Soumya Jagannath, Kedia Saurabh, Rout Gyanranjan, Thakur Bhaskar, Nayak Baibaswata, Kumar Ramesh
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India.
Division of Biostatistics, UT Southwestern Medical Center, Dallas, Texas 75390, United States.
World J Hepatol. 2022 Jul 27;14(7):1421-1437. doi: 10.4254/wjh.v14.i7.1421.
Platelet transfusion in acute variceal bleeding (AVB) is recommended by few guidelines and is common in routine clinical practice, even though the effect of thrombocytopenia and platelet transfusion on the outcomes of AVB is unclear.
To determine how platelet counts, platelets transfusions, and fresh frozen plasma transfusions affect the outcomes of AVB in cirrhosis patients in terms of bleeding control, rebleeding, and mortality.
Prospectively maintained database was used to analyze the outcomes of cirrhosis patients who presented with AVB. The outcomes were assessed as the risk of rebleeding at days 5 and 42, and risk of death at day 42, considering the platelet counts and platelet transfusion. Propensity score matching (PSM) was used to compare the outcomes in those who received platelet transfusion. Statistical comparisons were done using Kaplan-Meier curves with log-rank tests and Cox-proportional hazard model for rebleeding and for 42-d mortality.
The study included 913 patients, with 83.5% men, median age 45 years, and Model for End-stage Liver Disease score 14.7. Platelet count < 20 × 10/L, 20-50 × 10/L, and > 50 × 10/L were found in 23 (2.5%), 168 (18.4%), and 722 (79.1%) patients, respectively. Rebleeding rates were similar between the three platelet groups on days 5 and 42 (13%, 6.5%, and 4.7%, respectively, on days 5, = 0.150; and 21.7%, 17.3%, and 14.4%, respectively, on days 42, = 0.433). At day 42, the mortality rates for the three platelet groups were also similar (13.0%, 23.2%, and 17.2%, respectively, = 0.153). On PSM analysis patients receiving platelets transfusions ( = 89) had significantly higher rebleeding rates on day 5 (14.6% 4.5%; = 0.039) and day 42 (32.6% 15.7%; = 0.014), compared to those who didn't. The mortality rates were also higher among patients receiving platelets (25.8% 23.6%; = 0.862), although the difference was not significant. On multivariate analysis, platelet transfusion and not platelet count, was independently associated with 42-d rebleeding. Hepatic encephalopathy was independently associated with 42-d mortality.
Thrombocytopenia had no effect on rebleeding rates or mortality in cirrhosis patients with AVB; however, platelet transfusion increased rebleeding on days 5 and 42, with a higher but non-significant effect on mortality.
尽管血小板减少症和血小板输注对急性静脉曲张出血（AVB）结局的影响尚不清楚，但很少有指南推荐在AVB中进行血小板输注，且这在常规临床实践中很常见。
确定血小板计数、血小板输注和新鲜冰冻血浆输注如何影响肝硬化患者AVB在出血控制、再出血和死亡率方面的结局。
使用前瞻性维护的数据库分析出现AVB的肝硬化患者的结局。考虑血小板计数和血小板输注情况，将结局评估为第5天和第42天的再出血风险以及第42天的死亡风险。采用倾向评分匹配（PSM）比较接受血小板输注患者的结局。使用Kaplan-Meier曲线和对数秩检验以及Cox比例风险模型对再出血和42天死亡率进行统计比较。
该研究纳入913例患者，其中男性占83.5%，中位年龄45岁，终末期肝病模型评分14.7。血小板计数<20×10⁹/L、20 - 50×10⁹/L和>50×10⁹/L的患者分别有23例（2.5%）、168例（18.4%）和722例（79.1%）。在第5天和第42天，三个血小板组的再出血率相似（第5天分别为13%、6.5%和4.7%，P = 0.150；第42天分别为21.7%、17.3%和14.4%，P = 0.433）。在第42天，三个血小板组的死亡率也相似（分别为13.0%、23.2%和17.2%，P = 0.153）。PSM分析显示，与未接受血小板输注的患者相比，接受血小板输注的患者（n = 89）在第5天（14.6%对4.5%；P = 0.039）和第42天（32.6%对15.7%；P = 0.014）的再出血率显著更高。接受血小板输注的患者死亡率也更高（25.8%对23.6%；P = 0.862），尽管差异不显著。多因素分析显示，与血小板计数无关，血小板输注独立与42天再出血相关。肝性脑病独立与42天死亡率相关。
血小板减少症对肝硬化AVB患者的再出血率或死亡率无影响；然而，血小板输注在第5天和第42天增加了再出血，对死亡率有更高但不显著的影响。
