Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California San Francisco, San Francisco, California.
Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Vasc Interv Radiol. 2023 Aug;34(8):1364-1371. doi: 10.1016/j.jvir.2023.04.015. Epub 2023 Apr 24.
To evaluate recovery of platelet count after transjugular intrahepatic portosystemic shunt (TIPS) creation and patient factors predicting platelet recovery after TIPS creation.
Adults with cirrhosis who underwent TIPS creation at 9 U.S. hospitals from 2010 to 2015 were included in this retrospective analysis. Change in platelets from before TIPS to 4 months after TIPS creation was characterized. Logistic regression was used to assess factors associated with top quartile percentage platelet increase after TIPS. Subgroup analyses were performed among patients with a pre-TIPS platelet count of ≤50 ×10/L.
A total of 601 patients were included. The median absolute change in platelets was 1 × 10/L (-26 × 10/L to 25 × 10/L). Patients with top quartile percent platelet increase experienced ≥32% platelet increase. In multivariable analysis, pre-TIPS platelet counts (odds ratio [OR], 0.97 per 10/L; 95% CI, 0.97-0.98), age (OR, 1.24 per 5 years; 95% CI, 1.10-1.39), and pre-TIPS model for end-stage liver disease (MELD) scores (OR, 1.06 per point; 95% CI, 1.02-1.09) were associated with top quartile (≥32%) platelet increase. Ninety-four (16%) patients had a platelet count of ≤50 × 10/L before TIPS. The median absolute platelet change was 14 × 10/L (2 × 10/L to 34 × 10/L). Fifty-four percent of patients in this subgroup were in the top quartile for platelet increase. In multivariable logistic regression, age (OR, 1.50 per 5 years; 95% CI, 1.11-2.02) was the only factor associated with top quartile platelet increase in this subgroup.
TIPS creation did not result in significant platelet increase, except among patients with a platelet count of ≤50 × 10/L before TIPS. Lower pre-TIPS platelet counts, older age, and higher pre-TIPS MELD scores were associated with top quartile (≥32%) platelet increase in the entire cohort, whereas only older age was associated with this outcome in the patient subset with a pre-TIPS platelet count of ≤50 × 10/L.
评估经颈静脉肝内门体分流术（TIPS）创建后血小板计数的恢复情况，以及预测 TIPS 创建后血小板恢复的患者因素。
本回顾性分析纳入了 2010 年至 2015 年在美国 9 家医院接受 TIPS 治疗的肝硬化成人患者。分析 TIPS 治疗前至治疗后 4 个月血小板的变化。采用 logistic 回归评估 TIPS 后血小板百分比增加最高四分位的相关因素。在血小板计数治疗前≤50×10/L 的患者中进行亚组分析。
共纳入 601 例患者。血小板绝对值平均变化为 1×10/L（-26×10/L 至 25×10/L）。血小板百分比增加最高四分位的患者血小板增加≥32%。多变量分析显示，TIPS 治疗前血小板计数（比值比[OR]，每 10/L 增加 0.97；95%置信区间[CI]，0.97-0.98）、年龄（OR，每 5 岁增加 1.24；95%CI，1.10-1.39）和 TIPS 治疗前终末期肝病模型（MELD）评分（OR，每增加 1 分增加 1.06；95%CI，1.02-1.09）与血小板增加最高四分位（≥32%）相关。94 例（16%）患者 TIPS 治疗前血小板计数≤50×10/L。血小板绝对值平均变化为 14×10/L（2×10/L 至 34×10/L）。该亚组中 54%的患者血小板增加处于最高四分位。在多变量逻辑回归中，年龄（OR，每 5 岁增加 1.50；95%CI，1.11-2.02）是该亚组中唯一与血小板增加最高四分位相关的因素。
TIPS 治疗并未导致明显的血小板增加，除了治疗前血小板计数≤50×10/L 的患者。在整个队列中，较低的 TIPS 治疗前血小板计数、较大的年龄和较高的 TIPS 治疗前 MELD 评分与血小板增加最高四分位（≥32%）相关，而在 TIPS 治疗前血小板计数≤50×10/L 的患者亚组中，仅年龄与这一结果相关。
