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Title: Incidence, prevalence and clinical significance of abnormal hematological indices in compensated cirrhosis
Author: Qamar, A. A.
Grace, N. D.
Groszmann, Roberto J.
Garcia Tsao, Guadalupe
Bosch i Genover, Jaume
Burroughs, Andrew K.
Ripoll, Cristina
Maurer, R.
Planas, R.
Escorsell i Mañosa, M. Àngels
García Pagán, Juan Carlos
Patch, D.
Matloff, D. S.
Makuch, R.
Rendon, G.
Keywords: Cirrosi hepàtica
Assaigs clínics
Malalties del fetge
Hepatic cirrhosis
Clinical trials
Liver diseases
Issue Date: 12-Mar-2009
Publisher: Elsevier
Abstract: Background & Aims: Patients with cirrhosis develop abnormal hematologic indices (HI) from multiple factors, including hypersplenism. We aimed to analyze the sequence of events and determine whether abnormal HI has prog-nostic significance. Methods: We analyzed a database of 213 subjects with compensated cirrhosis without esopha-geal varices. Subjects were followed for approximately 9 years until the development of varices or variceal bleeding or completion of the study; 84 subjects developed varices. Abnormal HI was defined as anemia at baseline (hemoglo-bin,<13.5 g/dL for men and 11.5 g/dL for women), leuko-penia (white blood cell counts,<4000/mm 3 ), or thrombo-cytopenia (platelet counts, < 150,000/mm 3 ). The primary end points were death or transplant surgery. Results: Most subjects had thrombocytopenia at baseline. Kaplan-Meier analysis showed that leukopenia occurred by 30 months (95% confidence interval, 18.5-53.6), and anemia occurred by 39.6 months (95% confidence interval, 24.1-49.9). Baseline thrombocytopenia (P .0191) and leukope-nia (P.0383) were predictors of death or transplant, after adjusting for baseline hepatic venous pressure gradient (HVPG), and Child-Pugh scores. After a median of 5 years,a significant difference in death or transplant, mortality,and clinical decompensation was observed in patients who had leukopenia combined with thrombocytopenia at base- line compared with patients with normal HI (P < .0001). HVPG correlated with hemoglobin and white blood cell count (hemoglobin, r 0.35, P < .0001; white blood cell count, r 0.31, P < .0001). Conclusions: Thrombocy-topenia is the most common and first abnormal HI to occurin patients with cirrhosis, followed by leukopenia and anemia. A combination of leukopenia and thrombocytopenia at baselin predicted increased morbidity and mortality.
Note: Versió postprint del document publicat a:
It is part of: Clinical Gastroenterology and Hepatology, 2009, vol. 7, num. 6, p. 689-695
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ISSN: 1542-3565
Appears in Collections:Articles publicats en revistes (Medicina)

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