Birnbaum Jessie A, Herman Howard S, Gao Qi, Koenigsberg Mordecai, Sigal Samuel H
Albert Einstein College of Medicine, Bronx, New York.
Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
Gastro Hep Adv. 2022 Aug 29;2(1):8-15. doi: 10.1016/j.gastha.2022.07.022. eCollection 2023.
Thrombocytopenia is present in up to 76% of patients with chronic liver disease, and lower platelet counts (PCs) are associated with greater severity of portal hypertension. In this study, we assess the relationship of PC in patients with a clinical diagnosis of severe alcoholic hepatitis (SAH) with clinical severity and response to corticosteroid (CS) therapy.
Clinical characteristics, treatment, and hospital outcomes for patients admitted with SAH were analyzed from an electronic health record system. Patients were categorized based on admission PC (k/uL) into 5 categories: <50, 50-99, 100-149, 150-199, and ≥200. Frequency of complications (acute kidney injury, ascites, and hepatic encephalopathy), length of stay, and admission to an intensive care unit were analyzed across PC categories. Characteristics of patients who did and did not receive at least 4 days of CS therapy were compared.
Among 159 patients, 15 (9.4%) were in the PC < 50 category, 42 (26.4%) in PC 50-99, 51 (32%) in PC 100-149, 23 (14.5%) in PC 150-199, and 28 (17.6%) in PC ≥ 200. A higher admission PC was associated with greater white blood cell count, absolute neutrophil count, and total bilirubin ( < .05). Patients with higher PC on admission were more likely to receive steroids. PC was inversely associated with Lille score at treatment day 4 ( < .05).
A higher PC in SAH was associated with a greater inflammatory response and total bilirubin. Patients with a higher PC were more likely to receive CS and have a favorable treatment response.
高达76%的慢性肝病患者存在血小板减少症，较低的血小板计数与门静脉高压的更严重程度相关。在本研究中，我们评估临床诊断为重症酒精性肝炎（SAH）患者的血小板计数与临床严重程度及对皮质类固醇（CS）治疗反应之间的关系。
从电子健康记录系统分析SAH住院患者的临床特征、治疗及医院结局。根据入院时血小板计数（每微升千个）将患者分为5类：<50、50 - 99、100 - 149、150 - 199及≥200。分析各血小板计数类别中并发症（急性肾损伤、腹水和肝性脑病）的发生频率、住院时间及入住重症监护病房情况。比较接受至少4天CS治疗和未接受该治疗患者的特征。
159例患者中，血小板计数<50类有15例（9.4%），50 - 99类有42例（26.4%），100 - 149类有51例（32%），150 - 199类有23例（14.5%），≥200类有28例（17.6%）。较高的入院血小板计数与更高的白细胞计数、绝对中性粒细胞计数及总胆红素相关（P<0.05）。入院时血小板计数较高的患者更可能接受类固醇治疗。治疗第4天时血小板计数与 Lille评分呈负相关（P<0.05）。
SAH患者较高的血小板计数与更强的炎症反应及总胆红素相关。血小板计数较高的患者更可能接受CS治疗且治疗反应良好。
